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ROCK THE ARTS FOUNDATION POKER RUN
Saturday, September 18th, 2010
Pre-Registration: postmarked by Sept.13th Day of the event:
$10 rider/$5 passenger $15 rider/$10 passenger
Start: San Diego Harley-Davidson 5600 Kearny Mesa Rd, San Diego, CA
Destination: Bates Nut Farm 15954 Woods Valley Rd, Valley Center, CA 92082
(PLEASE PRINT) Participant Name:
Address:
City/State/Zip:
E-mail Address: Phone: ( )
Chapter/Club Name:
How did you hear about the Rock the Arts Ride? Quick Throttle Thunder Press Direct Mailer Internet Listing
Riders Review Radio/TV ÿ Chapter/Club Other: _____________
This is a release and indemnity agreement - read it before signing
In consideration of the Rock The Arts Foundation, permitting me, or my child under the age of 18, to participate in the above named event, I hereby, and for my or my child's heirs, executors, administrators, assigns, and all legal guardians, WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS OF ANY NATURE, FOUNDED IN WHOLE OR IN PART UPON ANY TYPE OF NEGLIGENCE OR FAULT, that I or my child may have against Rock The Arts Foundation, it’s directors, officers, employees, agents, chapters, assignees, licensees, volunteers and any above-named and any other cooperating entities, their representatives, heirs, executors, administrators, successors and assigns (“the Released Parties") arising out of or resulting from any and all injuries or damages of any nature, including death, which (I) (my child) may suffer while taking part in the event or any activities connected with the event. I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE any or all of the Released Parties in connection with the event.
(I AM) (MY CHILD IS) EXPERIENCED IN AND FAMILIAR WITH THE OPERATION OF MOTORCYCLES AND OTHER VEHICLES AND FULLY UNDERSTAND THE RISK AND DANGERS INHERENT IN MOTORCYCLING OR DRIVING OTHER TYPES OF VEHICLES in this type of event. (I am) (my child is) voluntarily participating in the event and I expressly agree to assume sole responsibility for the safe and successful operation of my motorcycle or other vehicles, and to accept the entire risk of any accidents or personal injury, including death, which (I) (my child) might suffer as a result of my participation in the event. I further understand that (I) (my child) assume(s) all risks in participating in the event.
Consent also is hereby given to use (my) (my child's) name, picture, portrait, likeness, writings or biographical information, and audiotape and/or videotape recordings and sound or silent motion pictures of (me) (my child) in any medium for editorial, educational, promotional and advertising purposes, for the solicitation of contributions, and/or for any other purpose in furtherance of the Corporate purposes and objectives of the Rock The Arts Foundation.
By signing this document, I certify that I have read this document and fully understand it, and that I am not relying on any statements or representations of any of the Released Parties. This document shall be binding upon me, my (my child's) heirs, executors, administrators and assigns (and all legal guardians of my child).
Signature of Participant: Date:
Signature of Parent or Guardian (if rider is under 18)*: Date:
DL#:
*I affirm that I am the parent/legal guardian of the above named rider/passenger and that I have full authority to authorize his/her participation in the above mentioned event.
Make pre-registration checks payable to: Catherine’s Dream 1721 Machado St. Oceanside, Ca 92054
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