Release for Participation

I, the undersigned, freely acknowledge and realize the dangers of participating in the Mountain Valley Hospice and Palliative Care Tour de Mayberry and fully assume all risks including, but not limited to, collision with pedestrians, vehicles, other riders or runners, and/or fixed or moving objects, the negligence of other riders/runners, sponsors, promoters, organizers, or drivers, and dangers arising from falls, road surfaces, equipment failure, inadequate safety equipment, weather conditions, as well the possibility of physical and/or mental trauma (or injury).

I understand that the route requires bicycling /running on public roadways and in bad weather and that cyclists /runners have been hospitalized and/or killed because of traffic mishaps that are either their responsibility or others’ responsibility and I further agree that I will bear all expenses incurred in any such accidents.

I realize that the Mountain Valley Hospice and Palliative Care Tour de Mayberry requires physical conditioning and I am in sound medical condition. I have no physical or medical impediment which would endanger myself or others. I understand and agree that a situation may arise during Tour de Mayberry which may be beyond the control of the sponsors, promoters or organizers and agree to ride so as not to endanger myself or others.

I waive, release, discharge for myself, my heirs, executors, administrators, legal representatives (including successors) any and all rights and/or claims which I have, may have or may hereafter occur to me against the sponsors, promoters or organizers of Mountain Valley Hospice and Palliative Care Tour de Mayberry, their employees and officers for any and all damages, injuries and claims which may be sustained by me directly or indirectly arising out of my participation in the Mountain Valley Hospice and Palliative Care Tour de Mayberry.

I authorize Mountain Valley Hospice & Palliative Care to disclose photographs of me for educational, marketing, and/or outreach activities, and that these activities may involve the creation of material to be distributed, displayed, or sold to the general public.

The above agreements and representative are my express understandings of the risks and I assume these voluntarily and freely without coercion or duress. This agreement may not be modified orally and may not be waived in any respect.

Pertaining to cyclists:   □ I accept responsibility for the condition and adequacy of my bicycle and agree to abide by the rules of the Tour de Mayberry relating to the wearing of a helmet as well as other organization requirements.

_____________________________________________________________________________________________

Signature                                                                                                          Date    

                         (parent/guardian for participation under age 18) 

THIS MUST BE SIGNED FOR YOUR PARTICIPATION IN THIS EVENT!

ALL RIDERS MUST WEAR A HELMET TO PARTICIPATE!!!