WEEKENDER BICYCLE TOURS REGISTRATION FORM
PLEASE PRINT:
TOUR:__________________________________________________________________________________
Name:______________________________________________ Phone:__________________________
Address:________________________________________________________________________________
Email:____________________________________ Age:_______________ Sex:_______________
Referral Name/Address:___________________________________________________________________
________________________________________________________________________________________
Previous Bicycle Tours:_____________________________________________________________________
Emergency Contacts:
Name:_________________________________ Relationship____________________ Phone_____________
Name:_________________________________ Relationship____________________ Phone_____________
*Please include a copy of your current medical insurance card with this form.
Please send this registration form and your payment to: Weekender Bicycle Tours
1680 Birmingham Lane, Crystal Lake, IL 60014
Weekender Bicycle Tours Liability Waiver
In signing this waiver, or as parent or legal guardian for the participant named above, I hereby release from responsibility and hold harmless from any claim, foreseen or unforeseen by me or my family, estate, heirs, or assigns, the following entities or persons: Weekender Bicycle Tours, its principles, directors, officers, agents, employees and volunteers, and each and every land owner, municipal and/or governmental agency upon whose property an activity is conducted from any and all claims, damages, demands, injuries, and losses whatsoever, arising from my transportation to, participation in and/or presence on the Weekender Bicycle Tour and do so entirely of my own initiative. I understand that riding a bicycle on a public street or road can be a risky and dangerous activity and may result in serious bodily injury, including permanent disability, paralysis and death (collectively "Risks"). I fully accept and assume all such risks and all responsibility for all costs, damages, and losses I incur as a result of my participation on the Weekender Bicycle Tour. I agree to wear a helmet, obey all traffic laws, and operate my bicycle in a safe manner. I certify that I have read this waiver, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely of my own free will and accord. If the participant is a minor, I the minor's parent or legal guardian understand the nature of bicycling activities and the minor's experience and capabilities and believe the minor to be qualified to participate on the Weekender Bicycle Tour. I further agree that I will supervise and accompany any and all minor children for whom I have co-signed. I also authorize emergency medical treatment if I or the above minor is injured & agree to pay all costs of rescue and/or medical services as may be incurred on my/our behalf. I recognize that you may find it necessary to terminate an activity due to forces of nature, medical necessities or problems in the group. I accept your right to take such actions for the safety of myself and/or other participants.
_________________________________________________________ ________________________________________________________
Printed Name of Participant Date Signature of Participant Date
If participant is under 18, still supported by parents, and/or living at home, parent or legal guardian must also sign.
_________________________________________________________________
Signature of Parent or Legal Guardian Date
