Registration for Rotary Ride

August 3, 2008

 

Please copy this form for each additional rider.

 

The starting location for the ride is at Crone Middle School in the south west part of Naperville.   The school is located on the corner of 111th & 248th St. (about 8 miles south of I-88 on Rt 59 and about 1 Mile west of Rt 59 on 111th).   Riders may start from 6:30 AM until 10:00 AM. 55, 85, & 102 mile riders are asked to leave before 8:30 AM SAG stops and support will close at 3:00 PM.

I PLAN TO RIDE (circle one):    20    40     55    85    102   MILES

Name_________________________________________________________________________

Address_______________________________________________________________________

City, State ZIP_____________________________________ Phone (____)__________________

Age________________ E-mail Address______________________________________________

T-Shirt Size:    ___Small       ___Medium      ___Large       ___X-Large

Please make checks payable to Rotary Club of Naperville, Sunrise.

Your cancelled check is your receipt. Send your Check, SIGNED registration form and the ride distance to:

Rotary Club of Naperville/Sunrise, P.O. Box 890, Naperville, Illinois 60566

or

Register Online at www.active.com (Click Here)

Please indicate if you have paid via ACTIVE.com so that we can cross reference payment.  No additional fee for registering online.

We will ride, rain or shine!

NAPERVILLE SUNRISE ROTARY CLUB'S BIKE RIDE

WAIVER AND RELEASE OF ALL CLAIMS

Please read the following carefully and be aware in registering yourself or your minor child/ward for participation in the Rotary Ride, you will be waiving and releasing all claims for injuries you or your minor child/ward might sustain arising out of the event:

I recognize and acknowledge that there are certain risks of physical injury to participants in the event and I agree to assume the full risk of any injuries, including death, illness, damage or loss, regardless of severity, which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with the bike ride.

I agree to waive and relinquish all claims I or my minor child/ward may have against the Rotary Club of Naperville-Sunrise, the City of Naperville, the Naperville Police Department, the Indian Prairie Community School District 204, the Oswegoland Park District Cross Evangelical Lutheran Church and School, the State of Illinois Department of Natural Resources and the Silver Springs Fish and Wildlife Area, and their officers, agents, servants, members and employees as a result of participating in the event.

I do hereby fully release and discharge the Rotary Club of Naperville-Sunrise, the City of Naperville, the Naperville Police Department, the Indian Prairie Community School District 204, the Oswegoland Park District, Cross Evangelical Lutheran Church and School, the Illinois Department of Natural Resources and the Silver Springs Fish and Wildlife Area, and their officers, agents, servants, members and employees from any and all claims from injuries, including death, illness, damage or loss, which I or my minor child/ward may have or may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with the activities of the event.

I further agree to indemnify and hold harmless and defend the Rotary Club of Naperville-Sunrise, the City of Naperville, the Naperville Police Department, the Indian Prairie Community School District 204, the Oswegoland Park District, Cross Evangelical Lutheran Church and School, the Illinois Department of Natural Resources and the Silver Springs Fish and Wildlife Area, and their officers, agents, servants, members and employees from any and all claims resulting from injuries, or illness, including death, damage or loss, sustained by me or my minor child/ward arising out of, connected with, or in any way associated with the activities of the event. I understand that this release and waiver of all claims applies to myself, my personal representatives, heirs and assigns. I know that cycling or the other events are potentially hazardous activities but represent that I am trained adequately, am medically able to participate in these events, and that my bicycle is in good condition and repair and is safe to ride. I assume all risks associated with cycling and the events included, but not limited to, falls, contact with other participants, crashes, effects of weather including high heat and/or humidity, traffic and road conditions. I understand that ANSI approved bicycle helmets must be work when participating in this event. I further understand that I must ride safely, including riding no more than two abreast, and in accordance with the rules of the road in the State of Illinois as they pertain to bicycle operation; I understand that should I fail to do so, I will be subject to removal from the ride.

I have read and fully understand the waiver and release of all claims.

X___________________________________________________________ (Signature of parent, guardian or adult participant)