Pre-Registration Form

You must be 18 years or older to ride in WBFK event on March 21, 2015.
Pre-registration form must be mailed by March 14,2015.

Name_____________________________________ DOB_____________, M ____, F ____

Address__________________________________________________________________
City_____________________________________ State________ Zip Code___________
Phone__________________ Email____________________________________________
I will ride (must check one): _____ Metric Century,

____ 30 Mile,

______11 Mile

Pre-Registration Fee: ____$35

Note: After March 7, 2015 There is no guarantee of shirt and the day of event registration fee will be $40.

Circle Shirt Choice:

Men's

Circle Shirt Size:

Women's
M

No Shirt

XL

Emergency Contact: _________________________________Ph_____________________

Rider's Signature ____________________________________Date____________________

Rider must also sign attached waivers
Mail signed application,
check and waiver to:
We Bike For Kids
P.O. Box 2166
Lady Lake, Fl 32158

Page 1 of 1

Contact:
Bernie Stopper
Ph. 315-729-1117
berniestopper@comcast.net

pre- registration form 2015 rev 1.docx

January 22, 2015

We Bike For Kids, The Villages, Inc. 2015 Waiver

We Bike For Kids and The Villages AGREEMENT AND LIABILITY WAIVER (the "Agreement and Waiver")
I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT, I AM ASSUMING RISKS, AND AGREEING TO INDEMNIFY, NOT TO
SUE AND RELEASE FROM LIABILITY THE ORGANIZERS OF THIS EVENT, WE BIKE FOR KIDS (WBFK) AND THEIR
RESPECTIVE AGENTS, INSURERS, EMPLOYEES, VOLUNTEERS, MEMBERS, CLUBS, OFFICIALS, SPONSORS, EVENT
DIRECTORS, LOCAL ASSOCIATIONS, AND AFFILLIATES (COLLECTIVELY RELEASEES), AND THAT I AM GIVING UP
SUBSTANTIAL LEGAL RIGHTS. THIS RELEASE IS A CONTRACT WITH LEGAL AND BINDING CONSEQUENCES AND IT
APPLIES TO ALL BICYCLING ACTIVITIES ENTERED AT THE EVENT, REGARDLESS WHETHER LISTED ABOVE. I HAVE
READ IT CAREFULLY BEFORE SIGNING, AND I UNDERSTAND WHAT IT MEANS AND WHAT I AM AGREEING TO BY
SIGNING. I ACKNOWLEDGE THAT CYCLING IS AN INHERENTLY DANGEROUS SPORT AND FULLY REALIZE THE
DANGERS OF PARTICIPATING IN THIS EVENT, whether as a rider, official, volunteer, spectator, or otherwise and FULLY ASSUME
THE RISKS ASSOCIATED WITH SUCH PARTICIPATION INCLUDING, by way of example, and not limitation: the dangers of collision
with pedestrians, vehicles, other riders, and fixed or moving objects; the dangers arising from surface hazards, including pot holes, equipment
failure, inadequate safety equipment, use of equipment or materials provided by the event organizer, sponsors, or others, THE RELEASEES
OWN NEGLIGENCE, the negligence of others and weather conditions; and the possibility of serious physical and/or mental trauma or injury,
or death associated with the event. For myself, my heirs, executors, administrators, legal representatives, assignees, and successors in interest
(collectively Successors) I HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNIFY AND
NOT TO SUE the Releasees and all sponsors, organizers, and promoting organizations, property owners, law enforcement agencies, public
entities, special districts and properties that are in a manner connected with this event, and their respective agents, officials, and employees
through or by which the event will be held, (the foregoing are also collectively deemed to be Releasees), FROM ANY AND ALL RIGHTS
AND CLAIMS INCLUDING CLAIMS ARISING FROM THE RELEASEES OWN NEGLIGENCE TO THE MAXIMUM EXTENT
PERMITTED BY LAW, which I have or which may hereafter accrue to me and from any and all damages which may be sustained by me
directly or indirectly in connection with, or arising out of, my participation in or association with the event, or travel to or return from the
event. I agree it is my sole responsibility to be familiar with the event course and agenda, the Releasees rules, and any special regulations for
the event and agree to comply with all such rules and regulations. I understand and agree that situations may arise during the event that may be
beyond the control of the Releasees and I must continually ride and otherwise participate so as neither endanger others nor myself. I accept
responsibility for the condition and adequacy of my equipment, any equipment provided for my use, and my conduct in connection with this
event. I will wear a helmet which satisfies the requirements of the Releasees Event Rules or Regulations and that can protect against serious
head injury, and assume all responsibility and liability for the selection of such a helmet and any modifications or attachments made thereto. I
have no physical or medical condition, which would endanger others or myself if I participate in this event, or would interfere with my ability
to safely participate in this event.
I agree, for myself and my Successors, that the above representations are contractually binding, and are not mere recitals, and that should I or
my Successors assert a claim contrary to what I have agreed to in this contract, the claiming party shall be liable for the expenses (including
legal fees) incurred by the Releasees in defending the claims. This contract may not be modified orally, and a waiver or modification of any
provision shall not be construed as a waiver or modification of any other provision herein or as a consent to any subsequent waiver or
modification. I consent to the release by any third party to Releasees and their insurance carriers of my name and medical condition that may
relate solely to any injury or death I may suffer arising from the event. Every term and provision of this contract is intended to be severable. If
any one or more of them is found to be unenforceable or invalid, that shall not affect the other terms and provisions, which shall remain
binding and enforceable.
I ATTEST THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER (OR THAT IF I AM YOUNGER, MY PARENTS OR LEGAL
GUARDIAN HAVE EXECUTED THIS WAIVER BELOW), AND THAT I AM PHYSICALLY FIT AND SUFFICIENTLY TRAINED TO
PARTICIPATE IN ALL ACTIVITIES ASSOCIATED WITH THE PROGRAM OR EVENTS AND MY PARTICIPATION IN SUCH
PROGRAM OR EVENTS IS VOLUNTARY

See Other Side of Page for Signature Section

Page 1 of 2

waiver tv n wbfk 2015 Rev 1.docx

January 22, 2015

We Bike For Kids, The Villages, Inc. 2015 Waiver

2015 Recreation Release Agreement
The Village Center Community Development District
Sumter Landing Community Development District
In consideration of being permitted to participate in recreational activities or events (the Activity or Activities) sponsored, promoted, held, or
conducted by the Activity Sponsor (as defined herein), I, for myself and for my executors, administrators, personal representatives, assigns, heirs,
and next of kin, DO HEREBY:
1.

2.
3.

4.
5.
6.

7.

RELEASE, WAIVE, FOREVER DISCHARGE, HOLD HARMLESS, AND COVENANT NOT TO SUE The Villages of Lake-Sumter,
Inc., The Villages Holding Company, The Villages Operating Company, The Village Center Community Development District, Sumter
Landing Community Development District, The Villages Recreation Department, The Villages Golf Department, Golf Management
Solutions, LLC, State of Florida Sports Foundation, any sponsor, advertiser, and promoter of any of the Activities, and any owner or
lessee of the premises where the Activities are held or conducted, and each of them, their officers, directors, members, executives, agents,
employees, affiliates, representatives, successors and assigns (collectively and individually referred to as the Activity Sponsor) of all
liability to me or my executors, administrators, personal representatives, assigns, heirs, and next of kin, for any and all loss or damage,
and all claims or demands therefore, on account of injury to my person or property or resulting in my death, arising out of or in any way
connected with my participation or involvement in or presence at the Activities, suffered before, during or after the Activities, whether
caused by the negligence, action or inaction of the Activity Sponsor or otherwise. This release applies for all future entrances to the
premises or this release applies each and every time a person is on the premises.
INDEMNIFY AND HOLD HARMLESS the Activity Sponsor from and against any loss, liability, damage or cost that I or any of my guests
may incur due to participation or involvement in or presence at the Activities, whether caused by negligence, action or inaction of the Activity
Sponsor or otherwise.
ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or in any
way connected with my participation or involvement in or presence at the Activities suffered before, during or after the Activities, whether
caused by the negligence, action or inaction of the Activity Sponsor or otherwise. I understand that my participation or involvement in or
presence at the Activities carry the risk of injury or death or property damage and I accept and assume that risk fully, freely and voluntarily.
AGREE that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by Florida law, and
that if any portion is held invalid for any reason, the balance should notwithstanding, continue in full legal force and effect.
AGREE that this release agreement is intended to apply to my or my guests participation or involvement in or presence at any Activity. The
Activity Sponsor has made no representations or inducements apart from the foregoing.
IRREVOCABLY GRANT to the Activity Sponsor the absolute right and permission to use any pictures, photographs, movies, images, videos,
recordings, or motion pictures taken of me or my property by the Activity Sponsor (collectively the Images) and to further use any statements,
quotes, recordings or testimonials made by me (collectively the Testimonials); To copyright the Images or Testimonials in the Activity
Sponsors own name or in any name Activity Sponsor may choose; To use, re-use, publish, display or reproduce the Images or Testimonials in
any medium and for any commercial purpose whatsoever, including but not limited to, promotion, advertising, display, sale or trade, without
restriction or limitation; To use my name in connection with the use of any such Images or Testimonials at the Activity Sponsors sole
discretion; all without compensation, royalty or remuneration of any kind. I waive any rights to inspect or approve the Images or the
Testimonials, their use, or any printed or audio matter that may be used in connection therewith, without restriction or limitation, whatsoever. I
hereby release and forever discharge the Activity Sponsor from any and all claims and demands arising out of or in connection with the use of
the Images or the Testimonials, including, but not limited to, any claims for slander, libel or invasion of privacy or right of publicity, as well as
any claims due to any technical failures or distortions in the Images or Testimonials that may occur in taking the original Images or
Testimonials, or in the subsequent processing thereof. I waive any right, title or interest in or to the Images or Testimonials and acknowledge
that the Activity Sponsor is the sole and absolute owner thereof and of any printed material, electronic media, negatives, film, video tape or
audio tape containing such Images or Testimonials.
AGREE to abide at all times to the following Code of Conduct at any Activity: The use of obscenity, profanity or vulgarity in any
conversations involving participants will not be tolerated. It is everyones responsibility to maintain a safe, pleasant and comfortable playing
atmosphere. Every individual who participates in this program has the right to be treated with respect. No one should be disparaged or
criticized in front of teammates and spectators. Bring your complaints or concerns to your recreation department representative. They will
investigate and address any concerns. I further agree that my participation or involvement in or presence at any Activity is a privilege rather
than a right, and that the Activity Sponsor reserves the right within its sole discretion to revoke my or my guests Activity Privileges, for
violations of the Code of Conduct.

I HAVE READ THE FOREGOING AGREEMENTS IN THERE ENTIRETY AND I HEREBY FREELY AND VOLUNTARILY SIGN
THESE AGREEMENTS, INTENDING TO BE BOUND THEREBY.

Participant Signature: ____________________________________________ Date: ______________________

Participant Name (Please Print): ________________________________________________________________
Street Address/City/State: ___________________________________________________________________________________________
Phone: _______________________________

Page 2 of 2

waiver tv n wbfk 2015 Rev 1.docx

January 22, 2015