BLAIR BIKE CLUB  Membership Form

To become a member, please print page, sign the form and mail in with your membership dues to the address provided below.

(circle one) I am a :  New Member or Renewing Member

Name   __________________________________________________________________

Phone  (____________) ____________________________________________

Address  _________________________________________________________________

City, State Zip  ____________________________________________________________

email  ___________________________________________________________________

Release Form & Waiver Liability, Assumption of Risk and Indemnity & Parental Consent Agreement.  The following must be signed by all adult applicants (18 years and older.)  All persons under the age of 18 must also have their parent's or guardian's signature.

IN CONSIDERATION of being permitted to participate in any way in BLAIR BIKE CLUB, club sponsored bicycling Activities ("Activity") I, for myself, my personal representatives, assigns heirs, and next of kin, 1. ACKNOWLEDGE, agree, and represent that I understand the nature of Bicycling Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity.  I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected.  I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.  2.  FULLY UNDERSTAND that (a) BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"), (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE 'RELEASEES' NAMED BELOW, (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at the time, and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.  3.   HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE BLAIR BIKE CLUB, their respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the 'RELEASEES' herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DEMANDS ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE 'RELEASEES' OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability damage, or cost any which may incur as the result of any such claim.  4.  AGREE TO OBEY ALL TRAFFIC LAWS & REGULATIONS, performing safely while riding and TO WEAR A HELMET WHILE RIDING.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

Signed ________________________________________Date ___________

Printed Name ___________________________________

Signed ________________________________________Date ___________

Printed Name ___________________________________

MINORS (UNDER 18 YEARS OF AGE)

I, THE MINOR'S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF BICYCLING ACTIVITIES AND THE MINOR'S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY.  I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE "RELEASEES" FROM ALL LIABILITY, CLAIMS, DEMANDS LOSSES, OR DAMAGES ON THE MINORS ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I , THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY WHICH MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

Parent or Guardian (if under 18) _________________________________

Names and Ages of Minors (under 18)

______________________________________       ________

______________________________________       ________

______________________________________       ________

MEDICAL ALERTS:_______________________________________

In case of emergency please contact:____________________________________

                                          Relationship:____________________________________

Home Phone:____________Work Phone:____________Cell Phone:_____________  

                Where did you hear about the Blair Bike Club?   

Would    Would you be willing to lead a ride (detailed description of ride leader responsibilities available)?  Y   N 

Woul       Would you like your name/ address to be available to other BBC members?   Y   N   

Mail       Mail all forms and fee’s to:    BBC
                                                  c/o Nannen PT
                                                  636 N 20th Ave
                                                  Blair, NE 68008

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