Please go here to pay your $20 regular adult rider fee at:  www.archildrens.org/GearsforEarsDonation

 

 

GEARS 4 EARS

ADULT WAIVER AND RELEASE FORM

 

I fully realize the dangers of participating in a bicycle ride and fully assume the risks associated with this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I acknowledge that my participation in this event is entirely voluntary and with a complete full understanding that the risks involved may result in harm, loss, personal injury or death.  I should not enter or participate unless I am medically able and properly trained.  I agree to abide by any decision of a race official relative to my ability to safely complete the bicycle ride.  Having read this waiver and knowing these facts and in consideration of your accepting my entry:

 

I hereby assume all risks and responsibilities for my participation and waive, release and discharge Arkansas Children’s Hospital Foundation Gears 4 Ears and other sponsors of this event, their officers, directors, employees and agents, for any harm, loss, personal injury, or death resulting from, arising out of, or in connections with my participation in this event.  

 

I CERTIFY THAT I HAVE READ THIS WAIVER AND RELEASE AND UNDERSTAND ITS SIGNIFICANCE.

 

Date: _____________________ Signature:_________________________________________

gears 4 ears participant

 

 

Signature of adult (21 or older) accompanying participants under 18: I am responsible for _______________________________, a minor rider  and understand I must assure he/she adheres to all rules of the event and immediately end my participation in the event if requested to do so by representatives of ACH for any medical, safety or other reason. I have advised the rider and the rider understands that should I have to end my participation in the event, the rider, too, will have to end his/her participation in the event.

 

Signature:________________________________________ Date: _________________