Entry Form and Liability Agreement
Please print and fill out one per rider. Mail form to Almaden Super Lions, P.O. Box 18511, San Jose, CA 95158 and check payable to So. San Jose Lions Foundation.
Name: ________________ Age: _____ Daytime Phone: ________ Email: _________
Street Address: __________________ City: ____________ State: ____ Zip: ________
Emergency Contact Name: ______________ Ph #: _____________ Relationship: ________
Route (Circle one): 100 mi 100 km 50 km 20 mi T-Shirt Size (Circle): S M L XL XXL
Registration Fees Enclosed: $__________ Additional Tax Deductible Donation: $___________ (Please make checks payable to "South San Jose Lions Foundation.")
(Fees: On or Before Feb. 1, 2012 : $45.00 single, $80.00 Tandem, $ 85.00 Family*. Between Feb. 1 and May 1, 2012 : $50.00 single, $85.00 Tandem, $ 90.00 Family*. After May 1, 2012: $55.00 single, $90.00 Tandem $95.00 Family*) * Family is 1 or 2 adults and their minor children
Liability Release:
For And In Consideration of acceptance of this entry or of my being permitted to take part in the I Care Classic Bicycling Tour event by the Almaden Super Lions Club, the South San Jose Super Lions Foundation, their members, respective agents, officers, servants, volunteers and representatives, Lions Club International, it's agents, employees and representatives, San Jose Unified School District and/or any other school district so involved, it's agents and employees, and any involved municipalities, their representative agents, and employees (hereinafter, "Releasees"), I, for myself, my heirs, executors, my administrators, successors and assignees, Do Hereby:
1) Understand that participating in Bicycling Events is inherently dangerous, and whether such events take place on public thoroughfares or off-road; whether in public or private areas; that there are ever present dangers and risks of injury or death from either my own actions or as the result of the actions of others over whom neither the Releasees nor I have any control. I will wear my helmet while a rider in this event and I assume all responsibility for selecting a helmet that fits me properly and can protect me against head injury.
2) I further acknowledge that I am aware of vehicle operation regulations imposed by the California Vehicle Code and of safety precautions involving equipment and clothing. I Assume All Risk for myself and assume all liability to others for my failure to have complied with those regulations and precautions, or for my failure to inspect my bicycle, and I therefore.
3) Release, Discharge and Covenant Not To Sue the Releasees from any and all claims and liability arising out of strict liability or ordinary negligence for any act which causes the undersigned injury, death, damages or property damages. I hereby covenant to hold Releasees harmless and to indemnify Releasees for any claim, judgment or expense Releasees may incur arising out of my activities in the I Care Classic Bicycling Tour Event.
I Have Read This Document. I Understand That It Is A Release Of All Claims. I Understand That I Assume All Risks Inherent In Bicycling Events. I Voluntarily Sign My Name Evidencing My Acceptance Of The Above Provisions And Conditions.
Name (Print ): _______________________ Signature: ____________________ Date: _______