ACCIDENT WAIVER AND RELEASE FROM LIABILITY 8:30 9:00 Registration Introduction of survivors and family members of those children who have lost the battle with cancer and release of sky lanterns in honor/memory. 9:30 Ride, Run & Hunt Bike through Hollidaysburg, run or walk around Legion Park track & digital scavenger hunt 10:00 Superhero Carnival Meet Spider-Man, Superman, Supergirl and a Ninja Turtle; photo booth; bouncy house; face painting; card making for cancer patients; Dennie Huber, Master Balloon Artist; music, games, prizes & more! 12:00 Picnic Hot dogs and other picnic food and presentation of Erin Dodson and Brian Morden Memorial Scholarships I fully realize the dangers associated with participating in an organized bicycle ride and/or run, and fully assume the risks associated with such participation including, by way of example, and not limited to, the following: the dangers of collision with pedestrians, vehicles, other riders and fixed or moving objects; the dangers arising from surface hazards, equipment failure, inadequate equipment, and weather conditions; and the possibility of serious physical and/or mental trauma or injury associated with recreational cycling and/or running events. I acknowledge that this Accident Waiver & Release of liability (AWRL) form will be used by the event holders, sponsors and organizers of the events in which I may participate and that it will govern my actions and responsibilities. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from this event, the following entities or persons: Brian Morden Foundation, their officers, employees, sponsors, organizers, volunteers, or any other representatives, or their successors & assigns of the TRide, Run, and Fun for Life event; (B) Indemnify and hold harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of any of my actions during this event. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident or illness during this event. I understand that at this event, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by event holders. This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. n with cancer! SIGNATURE/DATE SIGNATURE OF PARENT/ OR LEGAL GUARDIAN (if Participant is under 18) Benefitting childre Saturday,May 23RD, 2015 Legion Park,Hollidaysburg,PA 8:30AM - 1:00PM NOT ALL HEROES WEAR They per powers... don't fly or have su They can’t stop speeding bullets... push But they find their strength & ... limit the to es themselv Our heroes are the kids who fight cancer. And they do it with incredible courage. NAME __________________________________________________________DATE_____________________________________ ADDRESS________________________________________________________________________________________________ CITY __________________________________________________________STATE________________ZIP___________________ HOME PHONE_________________________________ CELL PHONE_________________________________________________ EMAIL _________________________________________________ DATE OF BIRTH______________ AGE___________________ SEX ❏ M ❏ F EMERGENCY CONTACT______________________________PHONE_____________________________ ❏ Check here to receive special information about the BMF via email (please include email address) PLEASE CHECK WHAT YOU WILL BE PARTICIPATING IN: ❏ Bicycling ❏ Run/Walk ❏ Digital Scavenger Hunt Helmets are mandatory for all riders. Riders must be age 7 and up if riding on their own bike (i.e. not tandem with parent, bike seat, etc.) ❏ REGISTRATION ON OR BEFORE MAY 8, 2015 $20 per person OR $35 per family (If you would like an event t-shirt, please choose the size below) ❏ REGISTRATION AFTER MAY 8, 2015 OR DAY OF EVENT $25 per person OR $35 per family (no T-shirt) PLEASE CHOOSE ONE: ❏ T-shirt (choose size below) SHIRT SIZE: Youth: ❏ S . JOIN THE.. RDEN BRIAN MO N IO FOUNDAT ank everyone As we honor & th fighting back against cancer. ❏ Superhero Carnival ❏M ❏ L ❏ Brian’s legacy gold ribbon Adult: ❏S ❏M ❏L ❏ BMF wrist band ❏ XL ❏ XXL ($1.00 additional) I will follow the instructions of the organizers, officials, and staff to the best of my ability. SIGNATURE_____________________________________________________ DATE_____________________________________ PRINT PARENT’S OR GUARDIAN’S NAME (if Participant is a minor)________________________________________________ PARENT’S/GUARDIAN’S SIGNATURE_____________________________________ DATE________________________________ Please mail completed form and waiver to: BRIAN MORDEN FOUNDATION, RIDE, RUN, & FUN FOR LIFE c/o Cathy Chirdon, 2407 Wopsy Road, Dysart, PA. 16636 Make checks payable to “The Brian Morden Foundation.” All proceeds benefit children with cancer. For more information and to register see brianmordenfoundation.org or call 946-3977. The BMF is a member of the Central Pennsylvania Community Foundation, a 501(c)(3) non-profit organization