 |

June
13, 2009
Sponsored
by the Rotary Club of Kernersville, NC
Register
HERE!
Held at the Dudley Inn, 900 E Mountain St, Kernersville |
|
|
|
| |
|
WAIVER (Your registration will NOT be processed unless
this is signed)
In consideration of being allowed to participate in any
way in Pedal the Piedmont related events and activities,
the undersigned acknowledges, appreciates and agrees that:
1. The risk of injury from the activities involved in
Pedal the Piedmont is significant, including the potential
for permanent paralysis and death; and,
2. I knowingly and freely assume all such risks, both
known and unknown, even if arising from the negligence
of the releasees or others, and assume full responsibility
for my participation; and, I further understand that obedience
of traffic regulations and signal devices is my responsibility;
and,
3. I willingly agree to comply with the stated and customary
terms and conditions for participation. If however, I
observe any unusual significant hazard during my participation,
I will remove myself from participation and bring such
to the attention of the nearest Pedal the Piedmont representative;
and,
4. I, for myself and on behalf of my heirs, assigns, personal
representatives and next of kin, hereby release and hold
harmless Pedal the Piedmont, their officers, officials,
agents, and/or employees, volunteers, other participants,
sponsoring agencies, sponsors, advertisers, and if applicable,
owners and lessors of premises used to conduct the event.
I understand and agree that the sponsors make no warranties
what so ever and are not responsible for ones safety
during Pedal the Piedmont or while traveling to and from
Pedal the Piedmont.
5. I grant to Pedal the Piedmont my permission to use
without charge any and all photographs, video reproductions
or other like kinds of image productions taken during
the event.
6. I understand that I can be removed from the ride at
any time for any reason with no refund.
7. I acknowledge that my registration fee is non-refundable
if I choose not to participate.
X_______________________________________________ Signature
Date: _______________________
Printed Name of Participant. *Parent or legal guardian
must sign if participant is under 18 years of age.

June 13, 2009…..2nd Annual Pedal the Piedmont |
|
|
|
|