2010ttreg&waiver

2010 ABD CYCLE CLUB INDOOR/OUTDOOR TIME TRIAL SERIES
For race information or to register online, go to
NAME (last name 1st):
ADDRESS:
CLUB (if applicable) :
Racing Age 2010:
WOMEN CAT
“PRIMARY CAT”
“SECOND CAT”
*Please Check
DESIRED STA
IES (INELIGIB
LE FOR MATTS)
*Please Check
c One in each c
WOMEN CAT
2nd Choice
REQUESTED
COMPETITOR
or Specific Start
( uniors <1
5, please indicate
a if you’
d lik to ra
5k or 10k)
RECUMBENTS
NUMBER OF RACES _______ x $25 per race (Juniors $12) add $3 late fee if within one week of an event ** See Discount Below** 2nd RACES OF DAY _______ x $17 per race ** See Discount Below** Series Discount Deal!! Register NOW for al 4 races for just $80 ($20ea.), Juniors race al 4 for
$45; Race 2nd Category @ ALL 4 races NOW for $15 per race ($60) TOTAL
To Register for the 2010 ABD TT Series send completed form along with check or money order payable to:
ABD Cycle Club, 17W461 Hill St., Villa Park, IL 60181
ENTRIES MUST BE RECEIVED AT LEAST 7 DAYS BEFORE THE EVENT- ANY ENTRIES RECEIVED WITHIN 7 DAYS
OF THE EVENT WILL NOT BE PROCESSED!!!
2010 Accident Waiver and Release of Liability
I acknowledge that this athletic event is an extreme test of a person's physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume al of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or control ed by them or because of their I certify that I am physical y fit, have sufficiently trained for participation in the event and have not been advised otherwise by a qualified medical person.
I acknowledge that this Accident Waiver and Release of Liability (AWRL) form wil be used by the event holders, sponsors and organizers, in which I may participate and that it wil govern my actions and responsibilities at said events.
In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as fol ows: (A) Waive, Release and Discharge from any and al liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: American Bicycle Racing, Inc., Community Middle School District 34, their directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event directors, event volunteers; (B) indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and al liabilities or claims made by other individuals or entities as a result of any of my actions during this event.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and or il ness during this event.
I understand that at this event or related activities, I may be photographed. I agree to al ow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and or assigns.
This AWRL shal be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I hereby certify that I have read this document; and, I understand it's content.
Signature of entrant:_________________________________________________________ ABR member number: ______________ Name of event : ABD 2010 Indoor Time Trial Series Date of events: 1/24/10 Indoor TT #1 2/21/10 Indoor TT #2 (any event you participate in on the above date(s) is covered by this single waiver ) Name, printed:___________________________________________________________________________________ ____________ Your address:________________________________________________ City, State & Zip:_________________________________
Your Phone Number:__________________________________________ Email Address:___________________________________
Cal in case of emergency:____________________________________________________ Phone:___________________________
Ability Category Entered: ___________________ OR Age Group Entered: _____________________ Racing Age:_________
Racing club: ______________________________ (if none enter “Unattached”)
PARENT GUARDIAN WAIVER FOR MINORS (Under 18 Years Old)
The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and al of the parties referred to above from al liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or Signature of Parent of Guardian___________________________________________________Date____________________________

Source: http://www.abdcycling.com/files/TT10_RegWaiver.pdf