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April 25th-29th, 2018

Major Taylor Cycling Club’s 

Liability Waiver, Indemnification Agreement, Permission to Provide Medical Treatment & Publicity Release

Read before signing.

In signing this agreement for myself or for the named participant (if the participant is under age 18), I know that those participating in this bicycling event will be exposed to the risks of serious bodily injury, sickness, death, or loss of property due to the circumstances inherent in cycling including the negligent acts or omissions of others. I also understand and am aware that there are a variety of specific risks and dangers inherent in a voluntary bicycling event including, without limitation, falls, collisions with other bicyclists, motor vehicles or stationary objects; adverse weather conditions; and those caused by conditions of the road. I also understand that by participating I will be riding my bicycle on public roads with many other bicyclists, some of whom may be inexperienced at riding in groups. I also understand that the large number of bicyclists participating, many of whom are inexperienced, adds a further element of danger.

I understand that by participating in this event I may suffer serious bodily injury, sickness, or death, while walking or travelling via bus or other motor vehicle or boat, due to my own carelessness or because of the negligence of others. I further understand that I may be exposed to these same risks while engaged in other voluntary activities such as dancing, swimming, and dining while participating.

I acknowledge that I (or the participant for whom I sign if under age 18) am physically capable and sufficiently trained for the completion of this event. I also attest that the equipment used by me (or the participant for whom I sign if under age 18) has been inspected by me and is in good mechanical condition and that I am familiar with its proper use. I am also aware that medical support for this event will be provided by volunteer and other personnel who may be called upon to provide assistance, including first aid, to me during the event. I consent and authorize any such volunteer to assist me (or the participant for whom I sign if under age 18) or to perform such assistance as, in the opinion of such person, may be necessary or appropriate. I understand further that any such medical or other services provided to me (or the participant for whom I sign if under age 18) is not an admission of liability to provide or to continue to provide any such services and is not a waiver by any of said parties’ rights under this agreement.

I understand that the Major Taylor Cycling Club assumes no responsibility or liability with respect to my participation in this event. I agree, however, to abide by any decision of any official of the Major Taylor Cycling Club relative to my ability to safely participate in this event. I further promise to wear a CPSC, ANSI, SNELL, or ASTM approved bicycle helmet at all times while riding my bicycle during the event and I agree to waive my rights to any benefits associated with this event if I fail to wear such a helmet while on my bicycle.

Having read this waiver and knowing these facts and in consideration of Major Taylor Cycling Club’s acceptance of my application for participation I, for myself and anyone entitled to act on my behalf, do hereby agree to release, hold harmless, and discharge the Major Taylor Cycling Club, all sponsors, representatives (including event volunteers), any involved municipalities or other organizations and the boards, trustees, officers, employees of any of them, from any and all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence, recklessness, or carelessness on the part of the persons or entities named in this waiver.

I also grant permission to the Major Taylor Cycling Club and its sponsors to use any photographs, motion pictures, recordings or any record of my participation in this event for legitimate purposes.

I further agree to indemnify and to hold harmless the persons and entities listed in this agreement for any liability they incur to me, a member of my family, or the participant in connection with this event.

I further agree that if, in breach of this agreement, I institute any judicial proceedings against any of the persons listed in this agreement in connection with this event, I shall bring them in the Common Pleas Court of Franklin County, Ohio, or in the United States District Court for the Southern District of Ohio, located in Columbus, Ohio, and I consent to personal jurisdiction in those courts. I further agree that, if in breach of this agreement, I institute any such proceedings, I am responsible for all costs and attorneys fees of any person or entity against whom I institute such proceedings.

HAVING READ AND UNDERSTOOD THIS
AGREEMENT, I VOLUNTARILY AND KNOWINGLY SIGN IT.

______________________________________________
Participant: Print your name above

X_________________________________
Participant: Sign & date above

_____________________________________________________________________
Date For Participants Age 15 and under: Have accompanying Adult print name above

For participants under age 18, CUSTODIAL PARENT OR
LEGAL GUARDIAN MUST SIGN BELOW
_________________________________________________
CONSENT AND RELEASE OF CUSTODIAL PARENT OR LEGAL GUARDIAN

X___________________________________

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