Pedal the Parkland Release Form

September 20, 2008

Please read carefully.  This form must be signed and returned with

the registration in order to participate in this event.

In consideration of the acceptance of this application, I hereby, for myself, my heirs, executors, administrators and assigns, and anyone entitled to act on my behalf, release and discharge the sponsors, directors, officials, employees and volunteers, from any kind of illness or damages suffered by me as a result of my participation in, or traveling to or from, the Pedal the Parkland Ride.

I know and understand that bicycling is potentially a hazardous activity.  I should not enter the Pedal the Parkland Ride unless I am medically able and properly trained.  I assume all risks associated with riding in the Pedal the Parkland ride, including, but not limited to:  falls, contact with other participants, the effect of weather, traffic and conditions to the roads; all risk being known and appreciated by me.  I realize that bicycling is a strenuous activity which requires proper physical conditioning.  I do hereby certify that I am in such physical condition and good health.  I agree to wear all appropriate equipment, including a helmet while riding in the Pedal the Parkland Ride.

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Print  name                                                                                                                                                                  

----------------------------------------------                                                                                              Signature                                                         

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Send application, release form, and payment to: 

Park Hills-Leadington Chamber of Commerce

#5 Municipal Drive

Park Hills Mo 63601-2064