Bearlodge Mtn Classic 2020

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Team name   First name   Last name   Email address   Year of birth 01    01       YYYY 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921    Gender -- Male Female   Phone #   Address   Emergency contact name   Emergency phone #   City   State / Province   Challenge Distance Choose one 8 mile Cub 14 mile Challenge 22 Mile Epic   Category Choose one Cub Boys Cub Girls Choose one Challenge Men Challenge Women Choose one Epic Men Epic Women   Event entry fee TBD

Adult t-shirt size None Small Medium Large Extra large Xxl Xxxl Want to purchase a cub T-shirt NoYes 10.00 USD Youth T-shirt size Choose one Y-Small Y-Medium Y-Large

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver 2020 Bearlodge Mtn Classic Sundance Chain Gang MTB Association, Sept. 20, 2020 ACCIDENT WAIVER, RELEASE OF LIABILITY, AND CONSENT FORM I acknowledge that this athletic event is an extreme test of a person’s physical and mental limits and participation in this recreational event or opportunity carries with it certain “inherent risks” as defined in the Wyoming Recreational Safety Act. Wyoming Statute (W.S.) Section (§) 1-1-123(a) states: “Any person who takes part in any sport or recreational opportunity assumes the inherent risks in that sport or recreational opportunity, whether those risks are known or unknown, and is legally responsible for any and all damage, injury or death to himself or other persons or property that results from the inherent risks in that sport or recreational opportunity.” As a provider of this recreational opportunity, the below-signed acknowledges that Sundance Chain Gang MTB Association (SCGMBA) “is not required to eliminate, alter or control the inherent risks within the particular sport or recreational opportunity” (W.S. § 1-1-123(b)). I have been advised to read the SCGMBA Accident Waiver, Release of Liability, and Consent Form carefully before signing. Assumption of inherent risk applies to all participants including but not limited to athletes, volunteers, sponsors, and support personnel, working directly or indirectly with or in support of the SCGMBA event. I hereby assume all risks of participating, traveling to and from this event, and/or volunteering in this event. I promise not to sue anyone associated with this event on my behalf or on behalf of my child regarding any claim arising from my child’s participation in this event. I certify that I am physically fit, have sufficiently trained for participation in the event, and have not been advised otherwise by qualified medical personnel. I acknowledge that this SCGMBA Accident Waiver, Release of Liability, and Consent Form applies to all activities associated with the 2018 Bearlodge Mtn. Classic and that it will govern my actions and responsibilities at the Sept. 20, 2020 --Bearlodge Mtn Classic and associated events. If you agree, please initial the next three items: _____ I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and/or illness during this event. ______I am aware that this event is not an event permitted by USA Cycling and that USA Cycling insurance does not apply. ______I understand that at this event or related activities I may be photographed. I agree to allow my photo, video and/or film likeness to be used for legitimate purposes by the event holders, producers, sponsors, organizers, promoters and/or assigns. The Sundance Chain Gang MTB Association Accident Waiver, Release of Liability, and Consent Form 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, I understand its contents, and sign this waiver and consent of my own free will. Signature of Entrant/Volunteer: ____________________________________________________ Date: ____________ CONSENT AND RELEASE OF PARENT OR GUARDIAN FOR MINORS (UNDER 18 YEARS OF AGE) The undersigned parent and/or natural guardian or legal guardian does hereby represent that he/she is signing on behalf of the minor participant. I have read and understand the above SCGMBA Accident Waiver, Release of Liability, and Consent Form and in consideration of allowing my child to participate, I agree that its terms shall likewise bind me, my child, my heirs, legal representatives, and assignees. I promise not to sue anyone associated with this event on my behalf or on behalf of my child regarding any claim arising from my child’s participation in this event. Signature of Parent or Guardian of Minor ____________________________________________________ Date _____________ I accept the terms of the waiver Name of parent or guardian who approves this activity