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CATSKILLS CYCLING CLUB — WAIVER AND RELEASE OF LIABILITY

WAIVER AND RELEASE OF LIABILITY — READ BEFORE SIGNING


In consideration of being allowed to participate in any way in the Catskills Cycling Club program and its related events and activities — including group and community rides, races, clinics and skills education, and volunteer activities — I, the undersigned, acknowledge, appreciate, and agree that:


1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,


2. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, FOREVER DISCHARGE, INDEMNIFY, AND HOLD HARMLESS Catskills Cycling Club and USA Cycling, Inc., their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law; and,


3. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,


4. I willingly agree to comply with the stated and customary terms and conditions for participation, including wearing a properly fitted helmet at all times while riding, obeying traffic laws, and riding so as to endanger neither myself nor others. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Club immediately.


I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.


PARENTAL / LEGAL GUARDIAN CONSENT (applies when a parent or legal guardian signs this agreement for a participant under 18 years of age): This is to certify that I, as parent/legal guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

First Participant's Name
First Name*
Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
Communications & Media Consent

Email communications: By signing this waiver, I agree that Catskills Cycling Club may email me about club rides, events, racing, and news. I can unsubscribe at any time using the link in any email.




Photo & video release: I grant Catskills Cycling Club permission to photograph and film me during club activities, and to use those images and recordings, without compensation, on the club's website, social media, and promotional materials. For any participant under 18, the parent or guardian grants this permission on the minor's behalf. I understand I may ask the club to remove a specific image of me at any time.

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
Cell phone *

Medical information (optional) — anything ride leaders should know: allergies, medical conditions, medications, etc.
Blood type (optional)
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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