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RIDE FOR LIFE ENTRY FORM

Click here to download a printable copy of registration form

Name:
Email:
Street Address:
City:
State:
Zip:
Phone:
Sex:
Over 18:
Fee Paid:
Fee for each bike is $20.00, passenger playing poker is $10:00
All other passengers are free
Participate in Bike Show:
If Yes, What Class
 
 
No extra fee to participate in Bike Show
Participate in Cruise In:
The cruse in will be Friday, May 21, 2010. Fee for the cruse in will be $10.00
 
LIABILITY RELEASE-I voluntarily request permission to participate in the Ride for Life fun run. I UNDERSTAND THE HAZARDOUS NATURE OF THIS ACTIVITY AND ACCEPT FULL RESPONSIBILITY FOR MY PARTICIPATION AND THE RISK INVOLVED, including by way of example and not limitation, dangers of collision with pedestrians, vehicles, other motorcycles, and fixed or moving objects, dangers arising from surface hazards, equipment failure, inadequate safety equipment, the released parties’ negligence, weather conditions and the possibility of serious physical and/or mental trauma or injury. I have no physical or mental condition, to m knowledge, which would endanger myself or others, or would interfere with my participation. I have inspected all of my personal equipment to be sure it is in good and safe condition. I agree to abide by all applicable laws and regulations and to act in a safe courteous manner. In consideration of permission to participate in the RIFE FOR LIFE, for myself, my heirs, executors, administrators, legal and personal representatives, successors and assigns, I DO HEREBY CHARGE, RELEASE, HOLD HARMLESS, PROMISE NOT TO SUE AND INDEMNIFY DONOR SERVICES OF INDIANA, THE HOOSIER BURN CAMP, FIRE AND IRON MOTORCYCLE ORGANIZATION, TODD’S TOWNLEY TAVERN, the officers, volunteers, and any other organization including sponsors, associations, municipalities, or individuals connected with the RIDE FOR LIFE from any and all claims, demands, rights, actions or causes of actions of whatsoever kind and nature arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to properties, and all of the consequences thereof which may hereafter be sustained by my participation in the RIDE FOR LIFE. In addition, I hereby consent to emergency treatment in the event of injury or illness.
 
Signed:(Participant)
Date:
 
Minors including individuals under 18 years of age must obtain SIGNATURE OF PARENT OR ADULT GUARDIAN. By signing this release, I as a parent or guardian of minor participating give permission to the terms of the above release.
Signed:(Parent/Gaurdian)
Date: