Your Signature (Adult / Parent / Guardian)

I hereby make known that I know there are risks involved with bicycling and agree to hold blameless the Northampton Cycling Club, volunteer ride leaders, workers providing support services, and participants in the bicycle event scheduled for today, and other dates I might ride in the future, in the event of accident, injury, death, misadventure regarding myself or loss or damage to my bicycling equipment. I understand that the routes taken are on public roads on which bicycle riding may be dangerous. I agree to assume full responsibility if I am injured, killed or suffer loss of property. I further agree to pay all reasonable attorney fees in the defense of any claims made relating to such activities. I hereby irrevocably consent to and grant Northampton Cycling Club the exclusive and unlimited right to use and reproduce any and all photographs, audio recordings, video recordings or testimonial accounts taken by Northampton Cycling Club that contain my person, name, image, voice, likeness or account.