Gut Check 212

GC 2010 Registration

Event Registration for Gut Check 2010

-Waiver & Release of Liability-
I wish to participate in the Highway 212 Gut Check, a bicycle endurance race to be held in South Dakota from August 11 or 13 – August 15 2010.

I understand that while participating in this race, I will be using public streets, highways, and facilities where many hazards exist and I am aware of and appreciate the risks that may result. I am also aware that accidents may occur during this event that may result in serious injury or death. I am voluntarily participating in the 212 Gut Check with knowledge of the dangers involved and I agree to accept all risks of injury or death. In consideration for being permitted to participate in the 212 Gut Check, I agree to assume all risks and to release, hold harmless, and covenant not to sue the Beneficiaries, and any sponsors, friends of the event, including the event staff and crew, officials, participating communities and clubs and all government and public entities including, but not limited to, the State, County and local municipalities where the event takes place, and all their respective directors, officers, agents, employees and members (collectively, the “Releasees”) for any claim, loss or liability that I may have arising directly or indirectly out of my participation in the event, including bodily injury, death or property damage, whether caused by negligence or carelessness of the Releasees or otherwise. I intend by this Waiver and Release to release, in advance, and to waive my rights and to discharge all of the Releasees from all claims, loss of liabilities for death, bodily injury or property damage that I may have, or which may hereafter accrue to me or my heirs, assigns or legal representatives, as a result of my participation in the 212 Gut Check, even though that liability may arise from negligence or carelessness on the part of the Releasees, from dangerous or defective property or equipment owned, maintained or controlled by them or because of their possible liability without fault. I understand and agree that this Waiver and Release is binding upon my heirs, assigns and legal representatives.

I verify that I am physically fit and that my physical condition has been or will be verified prior to the 212 Gut Check by a licensed medical practitioner. If I am a rider, I verify that I have or will train sufficiently to participate in the race. If however, as a result of my participation in the race I require medical attention, I give my consent to the authorized medical personnel of the 212 Gut Check to provide such medical care as is deemed necessary by such authorized personnel. I also understand that I will be financially responsible for the costs of any medical treatment. I verify that I have adequate medical insurance or will have such insurance at the time of the 212 Gut Check.

I will read the event description and rules for participation in the race and I will abide by all rules and regulations established by the race organizers and personnel as well as state and federal laws and local vehicle codes. I agree to wear a properly fitted and adjusted ASTM-, ANSI-, CPSC- or SNELL-certified helmet at all times while on my bicycle. I further agree that my participation in the Ride is subject to the sole discretion of the organizers of the race, and that my participation may be limited for medical or other safety reasons. I certify that I am or will be 18 years of age or older as of August 11, 2010 (for Hell & Back) or August 13, 2010 (for Gut Check). I understand that all donations received by the 212 Gut Check are non-refundable and non-transferable, even if I do not participate in the race. If I am registering as a rider, I understand that in order to participate, I must submit at least $100.00 no later than July 15th, 2010. I also understand that in the event the race cannot be held as scheduled due to any circumstances, the 212 Gut Check and the Beneficiaries are not obligated or liable to refund any money paid by or on behalf of me to participate, including but not limited to, any required or voluntary registration fee. I understand that my rider number is non-transferable.

I agree that my name, photograph, voice or likeness may be used by the 212 Gut Check, any of the Beneficiaries, and the race’s sponsors, licensees, affiliates and volunteers and staff. I consent to and authorize in advance, such use and waive all rights of privacy I have in connection therewith, and I understand that I will not benefit financially from any use thereof.

If any provision of this waiver shall be deemed unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect as if the unenforceable provision does not exist. I have carefully read this Waiver and Release and fully understand its contents. I am aware that by signing this Waiver and Release, I am waiving substantive legal rights and knowing this, I sign it of my own free will.

________ I agree

________ I decline

Signature: ____________________________

Date: _____________

Print Name: ___________________________

Signature of Parent or Guardian if participant is less than 18 years old on the date this Waiver and Release is signed.*
_____________________________________

*Riders and Crew who will not be accompanied on the Ride by a parent or legal guardian must be 18 years old on or before August 11, 2010 (Hell & Back) or August 13, 2010 (Gut Check).

IF MAILING REGISTRATION PLEASE RETURN THIS WAIVER ALONG WITH YOUR COMPLETED REGISTRATION FORM, PLEDGES, AND PLEDGE SHEET TO:

Josh Ellis
701 San Marco Blvd
Rapid City, SD 57702

IF REGISTERING ON-LINE JUST CHECK THE “YES” BOX BESIDE THE REGISTRATION QUESTION: I agree to the terms of the waiver and release of liability forms.