Online Registration Closed
If registered for this event, copy below, print, read, sign and email to flaglerbiking@gmail.com or turn in during event check-in!
Hard copies will be available at sign-in but by doing this early, it will save lots of time and confusion for everyone.
Hard copies will be available at sign-in but by doing this early, it will save lots of time and confusion for everyone.
Flagler Area Biking SORBA
Mountain Bike Time Trial Series
WAIVER AND RELEASE
Name of Participant: _________________________________________ Birth date: ___/___/___
Age: ______________
Gender: M □, F □
Parent/Guardian Name (if applicable):_______________________________________________
Address: ______________________________________________________________________
City, State, Zip:_________________________________________________________________
Phone #: __________________ (Home) __________________ (cell) E-mail:________________
T-Shirt Size: S □, M □, L □, XL □
Average lap time for the trail(s) (if known—this will help us with start order): _________________
Event: Fast Laps & Flapjacks Time Trial Series 2015
By indicating your acceptance, you (on behalf of yourself and/or minor child/ward) understand, agree, warrant and covenant as follows:
Liability and Publicity release: I know mountain biking (cycling) is a potentially hazardous activity, and I should not engage in cycling unless I am medically able to do so and am properly trained. I agree (on behalf of myself and minor child/ward) to utilize appropriate safety equipment, including but not limited to, a bike helmet. I assume all risks associated with cycling in this event including, but not limited to: falls, contact with other participants, the effects of weather, traffic, and course conditions, and agree for myself (and on behalf of my minor child/ward) to fully release, hold harmless and indemnify Flagler Area Biking, Southern Off Road
Bicycling Association, International Mountain Bicycling Association, Volusia County, its officers, employees, agents, sponsors, and volunteers from any and all claims related to any illness, injury, including loss of life, property damage, or loss of any other description which I (or my child/ward) may sustain arising out of, or in any way associated with, my (my child’s/ward’s) participation in the Mountain Bike Time Trial Series event. In the event of injury or illness, I authorize (on behalf of myself and my child/ward) Flagler Area Biking to obtain first aid and/or medical treatment at the nearest and most adequate facility of Flagler Area Biking choice. I am aware staff/volunteers may provide support for this program/event, including but not limited to the administration of: first aid, CPR (cardiopulmonary resuscitation), or the use of an AED (automated external defibrillator). I further give my permission for the free use of my (my child/ward) name, voice recording, or photo in any print account broadcast, telecast, or commercial advertising of the event. It is agreed that this document shall be interpreted according to the laws of the State of Florida.
By indicating your acceptance, you understand, agree, warrant and covenant for yourself and, if applicable, for your minor child/ward, as follows (if the participant is under 18 years of age, the parent/guardian must sign).
Signature: __________________________________________________________ Date: __________________
(Club Use Only)
Photo ID Checked: Y □, N □
Pre-registered: Y □, N □ If no, $________
Placard # ____________
Mountain Bike Time Trial Series
WAIVER AND RELEASE
Name of Participant: _________________________________________ Birth date: ___/___/___
Age: ______________
Gender: M □, F □
Parent/Guardian Name (if applicable):_______________________________________________
Address: ______________________________________________________________________
City, State, Zip:_________________________________________________________________
Phone #: __________________ (Home) __________________ (cell) E-mail:________________
T-Shirt Size: S □, M □, L □, XL □
Average lap time for the trail(s) (if known—this will help us with start order): _________________
Event: Fast Laps & Flapjacks Time Trial Series 2015
By indicating your acceptance, you (on behalf of yourself and/or minor child/ward) understand, agree, warrant and covenant as follows:
Liability and Publicity release: I know mountain biking (cycling) is a potentially hazardous activity, and I should not engage in cycling unless I am medically able to do so and am properly trained. I agree (on behalf of myself and minor child/ward) to utilize appropriate safety equipment, including but not limited to, a bike helmet. I assume all risks associated with cycling in this event including, but not limited to: falls, contact with other participants, the effects of weather, traffic, and course conditions, and agree for myself (and on behalf of my minor child/ward) to fully release, hold harmless and indemnify Flagler Area Biking, Southern Off Road
Bicycling Association, International Mountain Bicycling Association, Volusia County, its officers, employees, agents, sponsors, and volunteers from any and all claims related to any illness, injury, including loss of life, property damage, or loss of any other description which I (or my child/ward) may sustain arising out of, or in any way associated with, my (my child’s/ward’s) participation in the Mountain Bike Time Trial Series event. In the event of injury or illness, I authorize (on behalf of myself and my child/ward) Flagler Area Biking to obtain first aid and/or medical treatment at the nearest and most adequate facility of Flagler Area Biking choice. I am aware staff/volunteers may provide support for this program/event, including but not limited to the administration of: first aid, CPR (cardiopulmonary resuscitation), or the use of an AED (automated external defibrillator). I further give my permission for the free use of my (my child/ward) name, voice recording, or photo in any print account broadcast, telecast, or commercial advertising of the event. It is agreed that this document shall be interpreted according to the laws of the State of Florida.
By indicating your acceptance, you understand, agree, warrant and covenant for yourself and, if applicable, for your minor child/ward, as follows (if the participant is under 18 years of age, the parent/guardian must sign).
Signature: __________________________________________________________ Date: __________________
(Club Use Only)
Photo ID Checked: Y □, N □
Pre-registered: Y □, N □ If no, $________
Placard # ____________
