MTB Club Registration 2022

*Rider 1 First Name

*Rider 1 Last Name

*Rider 1 Age (as of June 1)

*Rider 1 is in good physical / mental health and is able to participate fully in all CamRock Youth Mountain Biking Club activities.

Yes

Rider 1 Requires an inhaler (asthma) and/or Epipen (allergy).

Inhaler

EpiPen

*Physician Name

*Physician Phone Number

*Health Insurance Company

*Health Insurance Policy/Group #

*I have a second child rider to register.

Yes

*Rider 2 First Name

*Rider 2 Last Name

*Rider 2 Age (as of June 1)

*Rider 2 is in good physical / mental health and is able to participate fully in all CamRock Youth Mountain Biking Club activities.

Yes

Rider 2 Requires an inhaler (asthma) and/or Epipen (allergy).

Inhaler

EpiPen

*Rider 2 Physician and Insurance information is the same as Rider 1.

Yes

*I have a third child rider to register.

Yes

*Rider 3 First Name

*Rider 3 Last Name

*Rider 3 Age (as of June 1)

*Rider 3 is in good physical / mental health and is able to participate fully in all CamRock Youth Mountain Biking Club activities.

Yes

Rider 3 Requires an inhaler (asthma) and/or Epipen (allergy).

Inhaler

EpiPen

*Rider 3 Physician and Insurance information is the same as Rider 1.

Yes

*I have a 4th child to register.

Yes

*Rider 4 First Name

*Rider 4 Last Name

*Rider 4 Age (as of June 1)

*Rider 4 is in good physical / mental health and is able to participate fully in all CamRock Youth Mountain Biking Club activities.

Yes

Rider 4 Requires an inhaler (asthma) and/or Epipen (allergy).

Inhaler

EpiPen

*Rider 4 Physician and Insurance information is the same as Rider 1.

Yes

*Physician Phone Number for Rider 4

*As a parent or legal guardian, I have provided accurate information about my son(s)/daughter(s) to CamRock Youth Mountain Biking Club (Organization) and authorize the Organization staff/volunteers/coaches to drive my son/daughter to the nearest emergency room or call an ambulance in case of injury needing emergency medical treatment should I or the emergency contact I have provided be unable to be reached. Every effort will be made to contact parent/guardian should any issue arise.Type Full Legal Name to acknowledge, consent, and agree to the above medical release. By typing your name, you agree to abide by the terms outlined in the medical release for the 2022 CamRock Youth MTB Club.

*Date Signed

In consideration of being allowed to participate in any way in the CamRock Youth Mountain Bike Club, its related events and activities, I,

, the undersigned, acknowledge, appreciate, and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS CamRock Youth Mountain Bike Club, their officers, officials, agents and/or employees, coaches, ride leaders, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

PARTICIPANT'S SIGNATURE FOR PARENTS/LEGAL GUARDIANS OF PARTICIPANTS OF MINORITY AGE

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

*Type Full Legal Name to acknowledge, consent, and agree to the above waiver and release. By typing your name, you agree to abide by the terms outlined in the waiver and release for the 2022 CamRock Youth MTB Club.

*Date of Signature of Waiver