Registration Form and LiabilityWaiver

Registration Form and Liability Waiver
Event Name: Manchester-Essex Rotary Club Annual Cycling Fundraiser
Event Date: October 26, 2025
Location: Start/Finish at Masconomo Park, Manchester, MA 01944 with multiple routes extending through Manchester, Gloucester and Essex, MA.

Waiver and Release of Liability

In consideration of being permitted to participate in the Manchester-Essex Rotary Club Cycling Event (“Event”), I, the undersigned participant (or legal guardian if under 18), acknowledge and agree to the following:
1. Assumption of Risk
  I understand that cycling on public roads involves inherent risks, including but not limited to collisions with vehicles, other cyclists, road hazards, weather conditions, and equipment failure. I voluntarily assume all risks associated with participation.
2. Release and Waiver
  I release and hold harmless the Manchester-Essex Rotary Club, its officers, members, volunteers, sponsors, and agents from any and all liability for injury, death, or property damage arising from participation in the Event, even if caused by negligence.
3. Indemnification
  I agree to indemnify and defend the Manchester-Essex Rotary Club against any claims brought by third parties arising from my actions during the Event.
4. Medical Consent
  I authorize event personnel to obtain medical treatment for me in case of emergency and agree to be responsible for any associated costs.
5. Photography Release
  I grant permission for the use of my image in promotional materials related to the Event.
6. Acknowledgment of Understanding
  I have read this waiver, understand its terms, and sign it freely and voluntarily.
Participant Consent and Waiver, Individual or Family Head.

Family is up to two adults and 5 minors
Individual Participant or Family Head Name*

First NameLast Name
If individual participant is under 18, check here for parent/guardian consent and waiver*

participant is 18 or olderparticipant is under 18
Parent/Guardian Name

First NameLast Name
Guardianship - all participants aged 13 and under must be accompanied on the ride by a legal guardian*

I am the legal guardian of all minors listed on this form and can sign on their behalfThere are no minors listed anywhere on this form
Acknowledgment of Understanding

I have read this waiver, understand its terms, and sign it freely and voluntarily for myself and any additional minor age family members listed below. By signing, I confirm I am not signing on behalf of any other adult participant.
Adult Participant, Family Head or Parent/Guardian Signature*

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Date*

MonthDayYear
Date
Adult Participant, Family Head or Parent/Guardian Phone Number*
Please enter a valid phone number.
Adult Participant, Family Head or Parent/Guardian Email*
example@example.com
Emergency Contact Name*

EC First NameEC Last Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Participant Consent and Waiver For Additional Family Members
Acknowledgment of Understanding

I have read this waiver, understand its terms, and sign it freely and voluntarily for myself.
Additional Adult Family Member Name

First NameLast Name
Acknowledgment of Understanding

I have read this waiver, understand its terms, and sign it freely and voluntarily for myself. By signing, I confirm I am not signing on behalf of any other adult participant.
Additional Adult Family Member Signature

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Additional Adult Family Member Email
example@example.com
Additional Minor Family Member 1 Name

First NameLast Name
Additional Minor Family Member 2 Name

First NameLast Name
Additional Minor Family Member 3 Name

First NameLast Name
Additional Minor Family Member 4 Name

First NameLast Name
Additional Minor Family Member 5 Name

First NameLast Name
Should be Empty:

Registration Form and Liability Waiver

Participant Consent and Waiver, Individual or Family Head.

Acknowledgment of Understanding

Participant Consent and Waiver For Additional Family Members

Acknowledgment of Understanding

Acknowledgment of Understanding