Registration Adult 2018

Tour d Orange Adult 2018

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RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT ("AGREEMENT") for MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY, DHN AN DT INSURANCE AGENCY

MINORS; Must be accompanied by an adult if 15 or under at all times. Tour d’Orange takes no responsibility for minors.

Minors must sign a waiver the day of the event with a legal guardian or parent who signs as well.

Rain or Shine, no refunds. Promotor has the right to alter routes for safety reasons or cancel the event in the case of weather.

IN CONSIDERATION of being permitted to participate in any way in Tour d'Orange Bicycling Activities/Tarwheels MS Ride ("Activity") I, for myself, my personal representatives, assigns, heirs, and next of kin am a member/or joining the Tarwheels MS Team for club purposes (emails/photographs/insurance) (not for New Bern).:

1. ACKNOWLEDGE, agree, and represent that I understand the nature of Bicycling Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.

2. FULLY UNDERSTAND that: (a) BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE TOUR D'ORANGE, THE ACTIVITIES CENTER OF CANE CREEK BAPTIST CHURCH, SYLVIA HILLER, TARWHEELS MS TEAM, TEAM MYELIN SHEATHS, UNC WELLNESS CENTER, VOLUNTEERS, ALL SPONSORS, MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY, DHN AND T INSURANCE AGENCY, CHATHAM, ALAMANCE, OR ORANGE COUNTIES, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the "Releasees" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE " RELEASEES " OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT, HAVE SIGNED IT VOLUNTARILY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

2. YOU UNDERSTAND THAT PARTICIPATION IN THE EVENT IS POTENTIALLY HAZARDOUS, AND THAT A REGISTERED PARTY SHOULD NOT PARTICIPATE UNLESS THEY ARE MEDICALLY ABLE AND PROPERLY TRAINED. YOU UNDERSTAND THAT EVENTS MAY BE HELD OVER PUBLIC ROADS AND FACILITES OPEN TO THE PUBLIC DURING THE EVENT AND UPON WHICH HAZARDS ARE TO BE EXPECTED. PARTICIPATION CARRIES WITH IT CERTAIN INHERENT RISKS THAT CANNOT BE ELIMINATED COMPLETELY RANGING FROM MINOR INJURIES TO CATASTROPHIC INJURIES INCLUDING DEATH. YOU UNDERSTAND AND AGREE THAT IN CONSIDERATION OF BEING PERMITTED TO PARTICIPATE IN THE EVENT, YOU AND ANY REGISTERED PARTY, THE HEIRS, PERSONAL REPRESENTATIVES OR ASSIGNS OF YOU OR THE REGISTERED PARTY DO HEREBY RELEASE, WAIVE, DISCHARGE AND CONVENANT NOT TO SUE ACTIVE FOR ANY AND ALL LIABILITY FROM ANY AND ALL CLAIMS ARISING FROM PARTICIPATION IN THE EVENT BY YOU OR ANY REGISTERED PARTY.

Rain or shine on August 25, no refunds. I HAVE READ THE ENTRY FORM INFORMATION PROVIDED AND CERTIFY MY UNDERSTANDING AND COMPLIANCE BY MY SIGNATURE BELOW

Name (if over 18):____________________ Address:___________________________________ Signature:____________________ Date:_____________Email Address:______________________________ Cell Phone:__________________ Other Phone:_______________ Route?: 30 63 80 101 miles

T shirt size; XS S M L XL XXL

Color; Royal Blue or Black

Emergency Contact 1:_____________________ Phone:_____________ Contact 2:_______________________ Phone:_________________

Be sure I receive it by 8/24/18. If not, I will have to charge you and shred the other. Send to: Sylvia Hiller, 402 Intern Way, Durham, NC 27713

Make check out to Tarwheels MS Team for $30 with shirt by 8/09/18, $25 no shirt thru 8/22, or $35 8/23 to 8/24, $45 day of.

Only Direct donations to the National Foundation for Transplants, memo line in honor of Glen Newhart for $50 will get you a free ride, if a receipt is shown on your cell phone (done on the day of) or emailed to 7sylvia41@gmail.com in advance. It will be tax deductible and you can ride for free. All other registration fees are not tax deductible.

No Refunds. Good Causes.