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Pedaling 4Kick Family Application

Pedaling for Kicks Family Registration Form
Helmets Required for all riders
Mail in Application for those who do not want to enter information on the internet.
*Important - Complete this page and then complete the following page where you
will be prompted for your Credit Card Information to pay for your participation charges.
If you do not complete the payment process your Registration will not be processed.
Payments are securely processed through PayPal
Family Registration (up to 7 riders)
Please fill out the following information, items marked with a * are required. When fininshed press the 'I AGREE' button which will allow access to the payment page.
First Name* Last Name*
Address City
State
Province
Zip  
Phone  Email*
Age  Sex  

  Please provide information about the other (6) riders
Name  Age  

 Sex

 
Name  Age  

 Sex

 
Name  Age  

 Sex

 
Name  Age  

 Sex

 
Name  Age  

 Sex

 
Name  Age  

 Sex

 

FELLOWSHIP OF CHRISTIAN FARMERS
CONSENT AND LIABILITY RELEASE - READ CAREFULLY


FELLOWSHIP OF CHRISTIAN FARMERS CONSENT AND LIABILITY RELEASE - READ CAREFULLY I request FELLOWSHIP OF CHRISTIAN FARMERS to allow me to participate in “Pedaling For Kicks”, Saturday, July 12, 2008.

    1. I understand that bicycling requires physical conditioning and I represent that I am in sound medical condition capable of participating in the ride without risk to myself or others. I have no known medical impediment which would endanger me or others. I agree that I will be solely responsible for the condition and adequacy of my bicycle, safety gear, and riding equipment. I will ride within the limits of my own abilities, my equipment and the riding conditions and in a manner so as to not endanger either myself or others. I undertand that helmets are required for all participating riders.

    2. I understand that bicycle riding is a potentially hazardous activity and I voluntarily participate in it of my own free will and choice. In choosing to attend this particular event, I fully accept and assume all risks whether before, during or after this event.

    3. Acknowledging that such risk exists, I HEREBY RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO HOLD HARMLESS THE FELLOWSHIP OF CHRISTIAN FARMERS, ITS OFFICERS, OFFICIALS, MEMBERS, AND VOLUNTEERS. This waiver and release of all claims, demands, actions and liability shall include, without limitation, any injury, damage or loss to my person or property which may be (a) caused by any act, or failure to act, by Releases even if said injury, damage, or loss results from the negligence of any or all of the above-identified Releasees or (b) sustained by me before, during or after this particular event.

    4. I agree to indemnify and hold harmless Releasees for all lawsuits, losses, damages, claims, and expenses, including attorney’s fees and costs arising from or relating in any respect to my participation in this particular event or my breach of this agreement. This provision will apply regardless of whether or not the lawsuit, losses, damages, claims, expenses, attorney’s fees and/or costs arises out of the negligence of any of the Releasees.

    5. If I am a minor, my parent or guardian is also signing on my behalf and we both agree to be bound by the terms of this agreement.

    6. The laws of the State of Illinois will govern any disputes or other matters relating to this Consent and Liability Release.

    THIS AGREEMENT MAY NOT BE MODIFIED ORALLY AND MAY NOT BE WAIVED IN ANY RESPECT. I HAVE READ THIS AGREEMENT, WAIVER AND RELEASE AND AGREE TO AND ACCEPT ITS TERMS.


    Acknowledging that such risk exists, I HEREBY RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO HOLD HARMLESS THE FELLOWSHIP OF CHRISTIAN FARMERS, ITS OFFICERS, OFFICIALS, MEMBERS, AND VOLUNTEERS, McLEAN COUNTY HIGHWAY DEPARTMENT AND ILLINOIS DEPARTMENT OF TRANSPORTATION. This waiver and release of all claims, demands, actions and liability shall include, without limitation, any injury, damage or loss to my person or property which may be (a) caused by any act, or failure to act, by Releases even if said injury, damage, or loss results from the negligence of any or all of the above-identified Releasees or (b) sustained by me before, during or after this particular event.

    I agree to indemnify and hold harmless Releasees for all lawsuits, losses, damages, claims, and expenses, including attorney’s fees and costs arising from or relating in any respect to my participation in this particular event or my breach of this agreement. This provision will apply regardless of whether or not the lawsuit, losses, damages, claims, expenses, attorney’s fees and/or costs arises out of the negligence of any of the Releasees.
    If I am a minor, my parent or guardian is also signing on my behalf and we both agree to be bound by the terms of this agreement.
    The laws of the State of Illinois will govern any disputes or other matters relating to this Consent and Liability Release.

    Family Acceptance Provision
    ALL PARTICIPANTS OVER THE AGE OF 18 MUST SEPARATELY DIGITALLY SIGN THIS AGREEMENT, WAIVER AND RELEASE. If you are 18 or older and listed above as a family rider, you must separately agree to this agreement, waiver and release.
    THIS AGREEMENT MAY NOT BE MODIFIED ORALLY AND MAY NOT BE WAIVED IN ANY RESPECT. IF THIS IS A FAMILY REGISTRATION, I,AFFIRM THAT I AM 18 YEARS OF AGE OR OLDER, AND THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE MINOR CHILDREN LISTED ABOVE. I FURTHER AGREE THAT I HAVE READ THIS AGREEMENT, WAIVER AND RELEASE AND AGREE TO AND ACCEPT ITS TERMS, BOTH FOR MYSELF AND MY MINOR CHILDREN, AND SO SIGNIFY BY PRESSING THE “I AGREE” BUTTON BELOW.
    I, AM THE SECOND ADULT LISTED ON THIS FAMILY APPLICATION. I ALSO HAVE READ THIS AGREEMENT, WAIVER AND RELEASE AND AGREE TO AND ACCEPT ITS TERMS AND SO SIGNIFY BY MY NAME BEING ENTERED HERE WHEN THE “I AGREE” BUTTON IS PRESSED.

    CLICKto unlock the I Agree button, by so doing I (We) further acknowledge that we agree to be bound by the above Agreement, Waiver, and Release, and have so indicated by digitally signing this document.

When the "I Agree" button is pushed you will be taken to the PAYMENT PAGE.
YOU MUST PAY THE FEES REQUIRED FOR YOUR APPLICATION TO BE COMPLETE.
IF FEES ARE NOT SUBMITTED IN THE FOLLOWING STEP YOUR REGISTRATION WILL BE CONSIDERED VOID.


  

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