Irvington Community Bike Ride

Registration Form

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Birthdate (MM/DD/YYYY)

Gender

Emergency Contact Information

Name

First Last

Relationship

How did you hear about Community Bike Ride?

How far are you traveling to participate in Community Bike Ride?

Do you belong to a cycling club? If so, which one?

Community Bike Ride Waiver and Release Form

I acknowledge that my participation in the Irvington Community Bike Ride held on Sunday, June 19, 2022 @8am involves a risk of injury, including bodily injury, and assume risk for same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by the law, I hereby release and discharge the Township of Irvington and the Irvington Public School District and their management, respective directors, officers, employees, affiliates, members, agents, sponsors, volunteers, organizers and representatives or their successors and all cooperating businesses and organizations, from any child and all claims without limitations arising from or growing out of my participation or that of my child in any aspect of the Community Bike Ride for any act or omission on the part of the Township of Irvington or the Irvington Public School District.

I attest and verify that I am medically able to participate and assume all risks of participation in this event. I understand that I may be photographed, filmed or videotaped at the event. I hereby irrevocably grant the Township of Irvington, its affiliates, licensees and collaborators the absolute right and permission to use my likeness and/or voice for any purpose whatsoever, including commercial advertising.

I also give my full permission for such first aid as deemed necessary to be provided to me on the premises or prior to transport to a hospital for further treatment. If I am an employee of the Township of Irvington or the Irvington Public School District, I acknowledge that my participation in the Community Bike Ride is completely voluntary and does not constitute part of my work-related duties. I understand that the herein waiver and release also applies to me. I also understand that my decision to participate, or not participate, in this activity will not affect my job status.

Name

First Last

Date

Signature

Email

Signature of Parent (If under 18years)

Date