Entry, 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 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, from dangerous or defective equipment or property owned,
maintained or controlled by them or because of their possible liability without fault.
I certify that I am physically 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 will be used by the event holders, sponsors and
organizers, in which I may participate and that it will 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 follows: (A) Waive, Release and Discharge from
any and all 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., their directors, officers, employees, volunteers, representatives, committee members,
members, and agents, the event holders, event sponsors, event directors, event volunteers; and any and any other party,
municipalities or other public entities connected with this event; (B) indemnify and Hold Harmless the entities or persons
mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of any of
my actions during this event, arising out of my travels to or returning from this event.
I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and or illness during this
I understand that at this event or related activities, I may be photographed. I agree to allow 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 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 it's content.
Signature of entrant ____________________________________________________________ Today's date __________________
Race Class Entered ___________. Your racing age & category listed on your racing membership/license card __________________.
Name of event _______________________________________________________________ Date of event __________________
Name, printed ____________________________________________________________ ABR Member number _______________
Your address ______________________________________ City, State & Zip __________________________________________
Your Phone Number ___________________________________ Email Address _________________________________________
Call in case of emergency _______________________________________________________ Phone ________________________
Racing Club / Sponsor ________________________________________________________________ (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 all of the parties referred to above from all 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 legal guardian.
Signature of Parent or Guardian_______________________________________________Date___________________________