Mr. Pork Chop Thaw Ride 2017
2013 |
Official Registration and Waiver Form of Liability Thaw Ride 2017 |
It is agreed that with respect to the event known as Thaw Ride 2017, each participant shall WAIVE all rights to recover for BODILY INJURY and hold harmless the City of Bancroft, Burt, Swea City, Lone Rock, Iowa, Kossuth County, Mr. Pork Chop, The Energy Spot and any of their representatives for ALL LIABILITY arising from participation in any related events or activities. The participant further acknowledges that Insurance DOES NOT apply to BODILY INJURY to any person while practicing for or participating in any contest or exhibition of an athletic or sports nature sponsored by the above named entities, nor to immediate medical or surgical relief to any person so injured.
Name:______________________________________________
Street Address:_______________________________________
City: ________________________State:_____Zip:___________
Check here if new address ( )
Email Address: _______________________________________
Signature:___________________________________________
Signature of guardian:_________________________________
(required if participant is under 18)
Ride Safety Notice: Due to staff reductions and potential hazards; public safety officials at the state, count, and local levels have requested that THAW riders depart from Bancroft at an appropriate item to ensure a safe return to Bancroft before sunset. They strongly suggest departing Bancroft for the ride by 1pm.
WEARING HELMETS IS STRONGLY ENCOURAGED!
Be sure to fill out the waiver form with signature and return the form with your check for $15 to:
The Energy Spot
219 W Seneca Rd
Bancroft, IA 50517