Single Track Mind Ride Entry & Release Form          Ride________________________________________________________ Date:______________________________                          

NOTICE:  THIS ENTRY AND RELEASE FORM IS A CONTRACT WITH LEGAL CONSEQUENCES. PLEASE READ IT CAREFULLY BEFORE SIGNING.

In consideration of the acceptance of my application for entry in the above named ride, I hereby freely agree to and make the following contractual representation and agreements.  I fully realize the dangers of participating in on road and off road bicycling and fully assume the risks associated with such participation including, by way of example, and not limitations, the following:  The dangers of collision with pedestrians, vehicles, other riders, and fixed or moving objects, the dangers arising from surface hazards, equipment failure, inadequate safety equipment, and weather conditions, the possibility of serious physical and/or mental trauma or injury or death associated with cycling.

It is understood and agreed that the participants in the event are not screened or tested for physical condition, skills, or qualifications, and that the equipment of the participants is not certified or warranted for the event and the undersigned is notre lying on the releases for the selection of competent participants or suitable equipment.

 I hereby waive, release, and discharge for myself, my heirs, executors, administrators, legal representatives, assigns, and successors in interest (herein collectively “successors”) any and all rights and claims which I have or which may hereafter occur to me against the sponsors of the event, and the promoter, Single Track Mind Cycling Club, and any other promoting organization(s), property owners, law enforcement agencies, all public entities, special districts and properties (and their respective agents, officials, employees) through or by which events will be held for any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation in association with the event, or travel to or return from the event.

I agree it is my sole responsibility to be familiar with the ride course, and any special regulations for this event.  I understand and agree that situations may arise during the ride which may be beyond the immediate control of the ride leader or organizers, and I must continually ride so as to neither endanger myself nor others.  I accept responsibility for the condition and adequacy of my equipment. I will ride wearing a helmet which meets ANSI, SNELL, and/or ASTM standards and that can protect against serious head injury, and assume all responsibility and liability for the selection of such a helmet.  I will carry appropriate clothing, food, water, and appropriate emergency equipment.  I have no physical or medical condition which to my knowledge, would endanger myself or others if I participate in this event, or would interfere with my ability to participate in this event.

I agree, for myself and successors, that the above representations are contractually binding, and are not mere recitals, and that should I or my successors assert my claim in contravention of this agreement, I or my successors shall be liable for the expenses (including legal fees) incurred by the other party or parties in defending, unless the other party or parties are finally adjudged liable on such a claim.  This agreement may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision herein or as a consent to any other provision herein or as a subsequent waiver of modification.  

Name                                          Signature                                  Emergency                    Emergency                     Member
                                                                                                     Phone                             Contact                             Y/N
1._______________________  _________________________ __________________ ___________________ _______

2._______________________  _________________________ __________________ ___________________ _______

3._______________________  _________________________ __________________ ___________________ _______

4._ ______________________  _________________________ __________________ ___________________ _______

5.  _______________________  _________________________ __________________ ___________________ _______

6. _______________________  _________________________ __________________ ___________________ _______

7. _______________________  _________________________ __________________ ___________________ _______

8. _______________________  _________________________ __________________ ___________________ _______

9. _______________________  _________________________ __________________ ___________________ _______

10._______________________  _________________________ __________________ ___________________ _______

11._______________________  _________________________ __________________ ___________________ _______

12._______________________  _________________________ __________________ ___________________ _______

13._______________________  _________________________ __________________ ___________________ _______

14._______________________  _________________________ __________________ ___________________ _______

 (note: Set printer to landscape before printing)