Compassion Run 2012

Saturday March 24th

Registration 9am.

MOTORCYCLE RIDE RELEASE FORM

THE UNDERSIGNED (ON MY OWN BEHALF AND ON THE BEHALF OF MY HEIRS, PERSONAL REPRESENTATIVES, SUCCESSORS AND ASSIGNS) , FOR AND IN CONSIDERATION OF THE OPPORTUNITY TO PATICIPATE IN THE “7TH ANNUAL COMPASSION RUN “ , HEREBY RELEASE THE “ 7TH ANNUAL COMPASSION RUN” , ITS ORGANIZERS, MEMBERS, AND OTHER PARTICIPANTS ON THIS MOTORCYCLE RIDE FROM ANY AND ALL CLAIMS AND DEMANDS, RIGHTS AND CAUSES OF ACTION OF ANY KIND WHATSOEVER WHICH I NOW HAVE OR LATER MAY HAVE RESULTING FROM, ARISING OUT OF OR IN CONNECTION WITH MY PARTICIPATION IN THIS RIDE.

THIS RELEASE EXTENDS TO ANY AND ALL CLAIMS I HAVE OR MAY HAVE AGAINST THE RELEASED PARTIES WHETHER SUCH CLAIMS RESULT FROM NEGLIGENCE (EXCEPT WILLFUL NEGLECT) ON THE PART OF ANY OR ALL RELEASED PARTIES WITH RESPECT TO THIS EVENT, OF WITH RESPECT TO THE CONDITIONS, QUALIFICATIONS, INSTRUCTIONS OR PROCEDURES UNDER WHICH THIS EVENT IS CONDUCTED OR FROM ANY INJURIES RESULTING TO MY PROPERT OR MYSELF DURING OR IN CONNECTION WITH THIS EVENT.

I AM EXPERIENCED & FAMILIAR WITH THE OPERATION OF MOTORCYCLES AND FULLY UNDERSTAND THE RISKS AND DANGERS INHERENT TO MOTORCYCLING. I AM VOLUNTARILY PARTICIPATED IN THE EVENT AND I EXPRESSLY AGREE TO ASSUME THE ENTIRE RISK OF ANY ACCIDENTS OR PERSONAL INJURY INCLUDING DEATH, WHICH I MIGHT SUFFER AS A RESULT OF MY PARTICIPATION IN THE EVENT WHETHER SUCH RISKS RESULTS FROM NEGLIGENCE (EXCEPT WILLFUL NEGLECT) ON THE PART OF ANY OR ALL OF THE RELEASED PARTIES.

THE UNDERSIGNED ACKNOWEDGES THAT THERE WILL BE NO ALCOHOLIC BEVERAGES SERVED AT THE RIDE DESTINATION, “EVANGEL TEMPLE 3800 BARNETT RD WICHITA FALLS, TX 76310) AND ANY CONSUMPTION OF ALCOHOLIC BEVERAGES WILL BE AT THE WILL OF THE UNDERSIGNED. THE RELEASED PARTIES STRONGLY ADVISE THE UNDERSIGNED NOT TO DRINK ALCOHOLIC BEVERAGES BEFORE OR DURING THIS EVENT, AND THAT IF THE UNDERSIGNED FEELS THAT HE/SHE IS THE SLIGHTEST BIT IMPAIRED, THAT THEY NOT PARTICIPATE IN THE RIDE. THE UNDERSIGNED ACKNOWEDGES THE RELEASED PARTIES HAVE EXPRESSLY INFORMED HIM/HER OF THE DANGERS OF DRINKING & DRIVING.

THIS IS A RELEASE - READ BEFOR SIGNING

BY SIGNING THIS RELEASE, I CERTIFY THAT I HAVE READ THIS RELEASE AND FULLY UNDERSTAND IT AND I AM NOT RELYING ON ANY STATEMENT OR REPRESENTATION OF ANYONE THEREBY AND DO CLAIM THAT I HAVE MOTORCYCLE INSURANCE AND A VAILD DRIVER’S LICENSE WITH A MOTORCYCLE ENDORSEMENT.

RIDER DATE ___________________________________________  PASSENGER/2ND RIDER DATE________________________

SIGNATURE ____________________________________________ SIGNATURE ________________________________________

PRINT NAME ___________________________________________ PRINT NAME _______________________________________

PHONE ________________________________________________ PHONE ____________________________________________

ADDRESS ______________________________________________ ADDRESS __________________________________________

CITY/ST/ZIP ____________________________________________ CITY/ST/ZIP _______________________________________

OPTIONAL:

EMAIL: ________________________________________________ EMAIL _____________________________________________

PRE-REGISTRATION:

NOW - MARCH 10, 2012

RIDER $15/ Dbl $20

RIDER $________ MAKE CHECKS PAYABLE TO:   Straight Street Ministry to Youth

                                                                                                PO Box 1684

                                                                                    Wichita Falls, TX 76307

Or Call with your Credit Card Straight Street Ministry to Youth 716-9898:

COMPASSION RUN 2012

Coins $10

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