35th Annual Brandywine Tour
Sunday, September 4th, 2011
Pre-registration Form

 

Name: ______________________________________

Address:_____________________________________

City:_____________ State: _____ Zip: __________

Phone: ________________ Age: ____

Email: ______________________________________________

(please check one)
Distance: 26 miles: ____ 50 miles ____ 65 miles ____ 80 miles ____ 100 miles ____ 

Waiver/Release

In consideration of the acceptance of my application for entry into the above event, I hereby waive, release, and discharge any and all claims for damages for death, personal injury, or property damage which I may have, or which may hereafter accrue to me, as a result of my participation in the said event. This release is intended to discharge in advance the promoters, the sponsors, the Delaware Valley Bicycle Club, the promoting clubs, the officials, and any involved municipalities or other public entities (and their respective agents and employees). form and against any and all liability arising out of or connected in any way with my participation in said event, even though that liability may arise out of negligence or carelessness on the part of the persons mentioned above.

I further understand that serious accidents occasionally occur during bicycle riding; and that participants in bicycle riding occasionally sustain mortal or serious personal injuries, and/or property damage, as a consequence thereof. Knowing the risks of bicycle riding, nevertheless, I hereby agree to assume those risks and to release and hold harmless all of the persons or entities mentioned above who (through negligence or carelessness) might otherwise be liable to me (or my heirs or assigns) for damages.

It is further understood and agreed that this waiver, release, and assumption of risk is to be binding to my heirs and assigns.

_____________________________        _____________________________
signature                                              signature

(If you are under 18 years of age, then your parent or guardian must sign)

PLEASE PRINT THIS FORM AND SEND ALONG WITH A CHECK OR MONEY ORDER TO:

35th Annual Brandywine Tour
The Delaware Valley Bicycle Club
P.O. BOX 156
Swarthmore, PA 19081