Event Sign-Up Sheet Template

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Event Sign-Up Sheet
I have read, understand and assent to the full “Release and Waiver of Liability, Assumption of Risk, and Indemnity and
Parental Consent Agreement” as found on the club web site at This waiver is summarized
as follows: I do hereby, for myself, my family, my heirs, executors, or administrators, release and forever, discharge any and
all rights and claims, for, or to be, for which I or members of my family may have or which may hereinafter accrue to me or
my family against the Southern Indiana Wheelmen Bicycle Association, Inc. (“SIW”), and/or any other persons connected
with the scheduled club activities, individually or collectively, for all responsibility for injury to persons and damage to
property during these activities.
Cyclists are required to wear a CPSC-approved helmet on all club rides.
Cyclists are expected to know and adhere to all rules of the road, and to exercise their rights
to the road in a responsible manner at all times.
Ride Captain: _________________________________________
RC Phone #: ____________________
Starting Point: _________________________________________
Date: ___________________________
MILEAGE
PHONE # & E-MAIL if you
NAME (Please sign clearly.)
are NOT a SIW member.
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rev. 1/6/16

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