2015 CASA Cycling for Children Acknowledgement of Risk ACKNOWLEDGMENT OF RISK AND DUTY OF CARE 1. I am signing this document as a condition to my registration fee and participation in the Cycling for Children Bike Ride. My signature on this document represents my express acknowledgment that the Cycling for Children Bike Ride in which I choose to participate involves inherent and other risks and that I could suffer injury or death while participating. I also understand that I have the right and opportunity to investigate and inspect facilities, equipment and areas to be used for the Cycling for Children Bike Ride, and, if I believe any of them are unsafe, I will immediately advise the person supervising the event, activity, facility, or area. 2. I am voluntarily participating in the Cycling for Children Bike Ride with an understanding of the risks and despite the existence of the risks, I choose to participate the in the Cycling for Children Bike Ride. 3. I acknowledge my personal responsibility to act reasonably under the particular circumstances of my participation. I agree to act responsibly and reasonably. I acknowledge the application of the Montana Recreation Responsibility Act, Title 27, Chapter 1, Part 7, MCA. 4. I agree that this Agreement shall be governed by and interpreted solely in accordance with Montana law. Any litigation involving the parties to this Agreement must be brought solely within the Montana State or Federal Courts, which shall have the exclusive jurisdiction over any such cause. 5. In signing this Agreement, I am not relying on any oral or written representations or statements made by representatives of the Cycling for Children Bike Ride, the local and national CASA organization, it’s employees, agents, volunteers, or representatives, other than what is set forth in this Agreement. 6. I agree that photographs, pictures, slides, movies, or videos of me may be taken in connection with my participation in the Cycling for Children Bike Ride without compensation from the local and national CASA organization, their officers, agents or employees and consent to the use of these photographs, pictures, slides, movies, or videos for any purpose. 7. I warrant that I am in good health and have no physical condition that would prevent me from participating in the Cycling for Children Bike Ride. 8. I acknowledge that the local and national CASA organization, their officers, agents, volunteers, or employees are not joint sponsors, joint venturers, partners, or otherwise jointly engaged in the above-named event or activity. This document relieves the local and National CASA organization, their officers, agents or employees and others from liability for personal injury, wrongful death, and property damage caused by negligence. I have read this document, understand that I have given up substantial rights by signing it, and sign voluntarily. PRINTED NAME SIGNATURE DATE Parent/Guardian Signature (if participant under the age of 18) Date JULY 25, 2015 CASA Cycling for Children Registration Form Name (print):__________________________________________________________________________________________________ Mailing Address:_______________________________________________________________________________________________ City/State/Zip:_________________________________________________________________________________________________ Email (for confirmation purposes):__________________________________________________________________________________ Phone:_______________________________ In case of an emergency notify:_______________________________________________ Registration Fee: 20 mile ride: $25 40 mile ride: $50 80 mile ride: $60 Late fee after July 22nd: $10 Optional Donation to CASA for Kids $________ $________ $________ $________ $________ Total Enclosed: $________ You will receive email confirmation for registration. CASA for Kids Online and paper registration is available. ($10 late fee after July 22). • Online registration (www.GetMeRegistered.com/CyclingForChildren) closes July 22nd. Mail-in registration must be postmarked by July 22nd.• For paper registration mail completed form and check payable to: CASA for Kids, Inc and mail to: CASA for Kids, Attn: Alicia Scofield, PO Box 11195, Kalispell, MT 59904 Packet Pick-up: Riders can pick up their packets from 4:00-6:30pm, Friday July 24 at Great Northern Cycles, 328 Central Ave, Whitefish, MT or after 7:00am ride day at the start location. Questions? Call Trish Bacsvany at 406-253-7320 or Alicia Scofield at 406-755-7208 Don’t Forget: 2015 Acknowledgement of Risk must be signed and sent with paper registration.
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