2005
Prairie State Tandem Rally
WAIVER
OF ALL LIABILITIES
In consideration of the acceptance of my registration for the Prairie State Tandem Rally, I hereby waive, release, and forever discharge any and all claims, demands, causes of action, and/or liability of every and any kind, including with and without limitation for damages for death, personal injury, or property damage which I may have or which may hereafter accrue to me on behalf of myself, my heirs, assigns, successors, estate, executers, trustees, and anyone else who may be acting on my behalf, that may arise as a result of my attendance and/or participation in said event and/or any related activities. This release is intended to act as a covenant not to sue and to discharge in advance the promoters, the sponsors, the promoting club and members thereof, and any other involved organizations, involved municipalities or other public entities ( and their respective agents and employees) (the “Released Parties”), from and against any and all liability arising out of or connected in any way with my participation in said event and any related activities, even though that liability may arise out of negligence or carelessness on the part of one or more of the Released Parties. In the event that I or anyone on my behalf makes any claim against any of the Released Parties for any claim, demand, cause of action, and/or liability, I will indemnify and hold harmless the Released Party against whom such a demand, cause of action, and/or liability is asserted against any and all losses, damages, claims, and expenses, including and without limitation attorneys’ fees and expert fees, incurred as a result of investigating and defending themselves against my assertion of such a claim, demand, cause of action, and/or liability. I acknowledge that bicycle riding may be a hazardous activity and I willingly, knowingly, voluntarily, and freely am assuming the risk of injury and/or death. I understand and agree that as a bicycle rider, I will wear a helmet and must obey all traffic regulations while riding in this event. It is further understood and agreed that this waiver and release and assumption of risk is binding on my heirs, assigns, successors, estate, executers, trustees, and anyone else who may be acting on my behalf.
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Captain’s Name_______________________________Signature__________________________________Date____________
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Stoker’s Name________________________________Signature__________________________________Date____________
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Guardian Name_______________________________Signature__________________________________Date____________
Rider #1 Name________________________________
Rider #2 Name________________________________
Rider #3 Name________________________________
EMERGENCY
CONTACTS
1st Choice
Name___________________________________ Relationship____________________ Phone__________________
2nd Choice
Name___________________________________ Relationship____________________ Phone__________________