Please use one form per rider (including those 12 and under).  This form may be copied.

MCBC 2009 UDDER CENTURY APPLICATION

Name:_______________________________________________________

Address:_______________________________City:___________________St:_______Zip:____________

Email:_______________________________________

                                                       By May 21st     After May 21st

        Riders age 13 and above -        $tba                      $tba

        Riders age 6 – 12                        $tba                        $tba

        Riders under 6                           Free                     Free

Circle anticipated miles:    32        50        62       75      100

Amount Paid $____________  Checks or Money Orders Only on Pre-Registered Entries

PLEASE READ AND SIGN BELOW (failure to sign will result in application being returned)

As a member or participant of the McHenry County Bicycle Club, I hereby wave, release and discharge any and all claims for damages, at law ore equity, including, not limited to, claims for death, personal injury or property damage which I may have hereafter accrued to me, as a direct or indirect result of my participation in the McHenry County Bicycle Club and its events.  This release is intended to discharge, in advance, McHenry County Bicycle Club, Inc., its successors and assigns, the promoters, the sponsors, the officials and any involved municipalities or other public entities (and their respective agents, directors, employees, members, successors and assigns) from and against any liabilities arising out of or connected with in any way with my participation in any and all McHenry County Bicycle Club activities and events, even though that liability may arise out of negligence ore carelessness on the part of the persons or entities mentioned above.

I agree that I will supervise and accompany throughout the ride any rider under the age of 16 that I have signed up as guardian for.  I understand that a helmet is required for each rider.  I further understand that serious accidents occasionally occur during bicycle events and that participants in bicycling sustain mortal or serious personal injuries and/or  property damage as a consequence thereof.  Knowing the risks of participating in bicycling events, I hereby agree to assume those risks and to release, indemnify and hold harmless all of the persons or entities mentioned above who might otherwise b liable to me for damages.  It is further understood and agreed that this waiver, release and assumption of risk is binding on my heirs and assigns.  I also understand that helmets are required, and following the Rules Of the Road is expected.

Signature of Rider or Guardian:_______________________________________Date:______________

 Mail to:  MCBC/Udder Century, PO Box 917, Crystal Lake, IL. 60039