Race Entry Form, Accident Waiver And Release Of Liability printable pdf download

RACE ENTRY FORM, ACCIDENT WAIVER

Event:

AND RELEASE OF LIABILITY

First Name:

1. I acknowledge that this athletic event is an extreme test of a person's physical and mental limits and

carries with it the potential for death, serious injury and property loss. The risks include, but are not limited

to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular

Last Name:

Racing Age:

tra c, actions of other people including, but not limited to, participants, volunteers, spectators, coaches,

event o cials and event monitors, and/or producers of the event, and lack of hydration. These risks are

not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of

participating and/or volunteering in this event. I realize that liability may arise from negligence or

Race Category:

carelessness on the part of the persons or entities being released, from dangerous or defective equipment

or property owned, maintained or controlled by them or because of their possible liability without fault.

First Race:

2. I certify that I am physically t, have su ciently trained to be a participant in the event and have not

Second Race (optional):

been advised otherwise by a quali ed medical person.

OBRA License #:

OBRA Race #:

3. I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by event

holders, sponsors and organizers, in events in which I may participate and that it will govern my actions

and responsibilities at said events.

Team:

4. 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,

E-mail:

Release and Discharge the Oregon Bicycling Association, their directors, o cers, employees, volunteers,

agents, event holders, event promoters, event sponsors, event volunteers, event permit grantors, event

property owners, and event participants, from any and all liability for my death, disability, personal injury,

Street:

property damage, property theft,lost income, or any other losses, costs or actions of any kind which

hereafter may accrue to me by virtue of my training for this event, my participation in this event or my

travel to or from this event; (B) Indemnify and Hold Harmless the entities or persons mentioned in this

City:

State:

ZIP:

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.

Phone:

5. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury,

accident and or illness during this event.

Who to notify in case of emergency:

Phone (emergency contact):

6. I understand that at this event or related activities, I may be photographed. I agree to allow my photo,

video or lm likeness to be used for any legitimate purpose by the event holders, producers, sponsors,

organizers and or assigns.

Signature Entrant:

Today’s Date:

7. IMPORTANT: OBRA and the organizers of this race do not provide insurance coverage for injuries that

occur at the race. The costs related to those injuries are the responsibility of the individual participant.

8. Bicycle use: Bicycles or bicycle equipment, wheels or other components may be loaned or borrowed

PARENT/GUARDIAN WAIVER FOR MINORS (under I8 years old):

for use in this event. A nominal charge may be collected to cover bicycle maintenance and purchase.

The undersigned parent and natural guardian or legal guardian does hereby represent

This is a loan and does not constitute a rental agreement. I understand that I assume responsibility for

that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and

the mechanical soundness of the bicycle and its parts, including but not limited to tires, gears, chain and

bolts. I have examined or will examine the bicycle and certify that it is properly assembled and t to ride.

indemnify each and all of the parties referred to above from all liability, loss, cost, claim or

I accept responsibility for damaged or lost equipment.

damage whatsoever which may be imposed upon said parties because of any defect

in or lack of such capacity to so act and release said parties on behalf of the minor and the

9. I have read and understand the materials regarding concussions posted at

parents or legal guardian.

Signature Parent/Guardian:

Today’s Date:

10. The AWRL shall be construed broadly to provide a release and waiver to the maximum extent

permissible under applicable law.

11. I hereby certify that I have read this document; and, I understand its content.

Race Entry Form, Accident Waiver And Release Of Liability

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