Bicycle Safety Rodeo Registration Form

Participants Information

Participant's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities during the bicycle safety rodeo. In exchange for the acceptance of said child’s participation, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless any/and all organizations and all its respective representatives from any and all liability for injuries to said child arising participating in the bicycle safety rodeo. In case of injury to said child, I hereby waive all claims against any/and all organizations, including all representatives, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including bicycling.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.