SOUTHERN MARYLAND MAY METRIC, Saturday, May 1, 2004
NAME________________________________________________________________________AGE______
ADDRESS_______________________________________________________________________________
CITY ______________________________________________________STATE______ZIP______________
PHONE__________________________________________EMAIL_________________________________
| I plan to ride
____the metric (63 miles) |
Registration Fee is $12 per rider
over 18 years and older by April 28, then $15. Make check payable to OHBTC and mail to:
|
RELEASE AND WAIVER OF LIABILITY,
ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT:
In consideration for being permitted to
participate in this Oxon Hill Bicycle and Trail Club sponsored bicycle ride I,
for myself, my personal representatives, assigns, heirs, and next of kin:
1. ACKNOWLEDGE, agree, and represent that
I understand the nature of bicycling activities and that I am qualified to
participate in such activity. I further acknowledge that the activity will be
conducted over public roads and facilities open to the public during the
activity and upon which the hazards of traveling are to be expected. I will obey
all Maryland traffic laws and practice safe cycling. I further agree and warrant
that if at any time I believe conditions to be unsafe, I will immediately
discontinue further participation in the activity.
2. FULLY UNDERSTAND that: (a) Bicycling
activities involve risks and dangers of serious bodily injury, including
permanent disability, paralysis, and death ("risks"); (b) these risks and
dangers may be caused by my own actions or inactions, the actions or inactions
of others participating in the activity, the condition in which the activity
takes place, or the negligence of the "releasees" named below; there may
be other risks and social and economic losses either not known to me or not
readily forseeable at this time; and I FULLY ACCEPT and assume all such risks
and all responsibility for losses, costs, and damages I incur as a result of my
participation or that of the minor in the activity.
3. HEREBY RELEASE, DISCHARGE, AND
COVENANT NOT TO SUE the club, the LAB, M-NCPPC, DNR, their respective
administrators, directors, agents, officers, members, volunteers, other
participants, any sponsors, advertisers and, if applicable, owners, lessors and
employees of premises on which the activity takes place, (each considered one of
the "releasees" herein) from all liability, claims, demands, losses or damages
on my account caused, or alleged to be caused in whole or in part by the
negligence of the "releasees" or otherwise, including negligent rescue
operations; and I further agree that if, despite this agreement I, or anyone on
my behalf, makes a claim against any of the releasees, I will indemnify, save,
and hold harmless each of the releasees from any litigation expenses, attorney
fees, loss, liability, damage, or cost which any may incur as the result of such
claim.
4. CONSENT TO EMERGENCY MEDICAL TREATMENT
in the event of injury or illness.
5. Any images of me participating in this event can be used for promotion of
bicycling and other events by the Oxon Hill Bicycle and Trail Club.
I HAVE READ THIS AGREEMENT, UNDERSTAND
ITS TERMS AND FULLY AGREE TO THEM.
Participant’s signature____________________________________________Date_______________________
Emergency contact _____________________________________Emergency Phone
____________________
ADDITIONAL MINOR RELEASE FOR RIDERS
UNDER 18:
AND I, THE PARENT AND/OR LEGAL GUARDIAN
OF THE ABOVE NAMED MINOR HEREBY GIVE MY PERMISSION AND CONSENT VOLUNTARILY AND
FREELY FOR MY CHILD TO PARTICIPATE IN THE SOUTHERN MARYLAND MAY METRIC RIDE. I
further agree individually and on behalf of my child to the above terms after
having fully read the terms.
Parent/Guardian’s signature_______________________________________________Date_____________________________
Printed name of Parent/Guardian_________________________________________Phone____________________________