RACE REGISTRATION FORM
This form must be read carefully, filled out completely and signed by each racer.  You may bring the completed form to the race with you.  

EVENT NAME: _________________________________________    DATE:________________

WVMBA MEMBER: Yes   No       ENTRY FEES:  ($35.00) NON-MEMBER    ($30.00) WVMBA MEMBER          Cash Check

                 ENTRANT NAME: AGE: DOB:

                 ADDRESS:CITY:STATE:

                 ZIP:PHONE: (DAY) (NIGHT) E-mail:

                EMER. CONTACT:EMER. PH:TEAM or SPONSOR:

STOP! YOU MUST READ AND CHECK EACH ITEM BEFORE SIGNING!

ACCIDENT WAIVER & RELEASE OF LIABILITY AGREEMENT

• I acknowledge that this athletic event is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, fixed or moving objects, actions of other people including but not limited to, participants, volunteers, spectators, coaches, event officials, event monitors, producers of the event and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby agree to assume all of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective property owned, maintained or controlled by them or because of their liability without fault.
• I certify that I have no physical or medical condition which, to my knowledge, would endanger myself or others and that I have trained sufficiently for participating in this event and have not been advised otherwise by a qualified medical person.
• I acknowledge that it is my sole responsibility to be familiar with the race course, the event rules, and any special regulations for the event. I understand and agree that situations may arise during the event which may be beyond the immediate control of the event officials or organizers, and I must continually ride so as to neither endanger myself nor others. I accept responsibility for the condition and adequacy of my competition equipment. I will compete wearing a helmet which satisfies the requirements of the event rules and regulations and that can protect against serious head injury, and I assume all responsibility and liability for the selection of such a helmet.
• I acknowledge that this Accident Waiver and Release of Liability (AWRL) agreement will be used by the event holders, sponsors, organizers, or others in which I may participate and that it will govern my actions and responsibilities at said events.
• In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: The West Virginia Mountain Bike Association, affiliated organizations and any involved municipalities, their directors, officers, employees, volunteers, representatives or agents, the event holders, event directors, event sponsors, event volunteers, property owners: (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by the negligence of releases or otherwise.
• I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and/or illness during this event.
• I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, organizers and/or assigns.
• This Accident Waiver and Release of Liability Agreement shall be construed broadly to provide a release and waiver to the maximum permissible under applicable law.
• I further agree to abide by all the rules and regulations as set forth by the director of this event.
• I hereby certify that I have read this document and I understand its contents.

                   Entrants Signature:______________________________ Date: ________________

                Note: If entrant is age 17 or under, Signature of Parent or Guardian is required below)

        My Child is fit for the above stated event, and I consent to my Child's participation. I have read and I understand the Accident Waiver and Release of Liability (AWRL) agreement. In consideration of allowing my      Child to participate, I consent to it and agree that its terms shall likewise bind me, my child, my heirs, legal representatives, and assignees. I hereby release and shall defend, indemnify and hold harmless the event holders, sponsors, organizers or others from every claim and any liability that I or my Child may allege against the event holders, sponsors, organizers or others (including reasonable attorney's fees or costs) as a direct or indirect result of injury to me or my Child because of my Child's participation in this event, whether caused by the negligence of the event holders, sponsors, organizers or others. I promise not to sue the event holders, sponsors, organizers or others on my behalf or on behalf of my Child regarding any claim arising from my Child's participation in this event.

         Signature of Parent or Guardian: ________________________________ Date: ___________