Meadows Monster "Dual at Dawn"

Saturday, October 28, 2017 9:00 AM (GMT-6)

Event info
Sport: Duathlon - bike and run
Location: Dixon, IL, United States
Registrations: 2
Registration closes: Friday, October 27, 2017 11:59 PM (GMT-6)
Organized by: Meadows Monster
Event website: www.meadowsmonster.com
Event notes
2 mile run - 10 mile bike - 2 mile run

Pre-register before Oct. 16th to guarantee your (unisex) t-shirt!
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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver
Entry Form / Release Form
Meadows Monster - XC Duathlon
October 28, 2017 – 9:00 AM
Lowell Park – Dixon, Illinois

Name: _________________________________________________ Age: __________ Gender: Male / Female

Address: ________________________________________________ City: ________________ Zip: _________

E-mail: _______________________________________________________________ (FOR RACE RESULTS)

Emergency Contact: ___________________________________________Phone: ________________________

Team Entry (Relay only):

Team Name: ______________________________________________________________________________

Runner: __________________________________________________________________________________

Cyclist: ___________________________________________________________________________________

Runner: (Optional) ________________________________________________________________________


Waiver and Release of Liability Agreement


NOTE: Each Relay Team member will be required to sign a waiver on the day of the event.

I, the undersigned, hereby acknowledge and understand that the athletic event commonly known as the Meadows Monster Challenge XC Duathlon held on Saturday, October 28, 2017, at Lowell and Meadows Park located in Lee County, Illinois (the “Event”), is an extreme test of individual physical and mental limits and carries with it certain risks including, but not limited to, death, serious injury and property loss, caused by such things as nutrition, hydration, terrain, facilities, weather conditions, equipment, vehicular traffic, actions of other people such as participants, volunteers, spectators, coaches, officials, and/or organizers of this Event. I acknowledge that these risks are inherent in athletic events of this type. I hereby assume all 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 hereby and/or from dangerous or defective equipment or property owned, maintained or controlled by them. I certify that I am physically fit and prepared to participate in this Event and have not been advised otherwise by qualified medical personnel. I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers of the Event and that it will govern my actions and responsibilities at the Event. In consideration of my application and allowing me to participate in the event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

I expressly and voluntarily Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, and/or property theft, the following entities or persons: the Dixon Park District, City of Dixon, County of Lee, the Event organizers, directors, sponsors, volunteers, and any and all officers, employees, volunteers and agents of the foregoing entities/organizations (collectively, the “Released Parties”). Further, I expressly and voluntarily Indemnify and Hold Harmless the Released Parties from any and all liabilities or claims made as a result of participation in the event, whether resulting from one’s negligence or otherwise.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during the Event. I understand that during the Event or related activities, I may be videotaped and/or photographed. I agree to allow my photo, video, film and/or other electronic likeness to be used for any legitimate purpose by the Event holders, producers, sponsors, organizers and their assigns.

This Accident Waiver and Release of Liability shall 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 its content.

Signature: ___________________________________________________________________

Date: ______________________

Signature of Guardian (if participant is under 18): ____________________________________________________

Date: ______________________

Name of parent or guardian who approves this activity