Founded 1888
 Tacoma Wheelmen's Bicycle Club
Tacoma, WA 984111
 
Name of Ride:____________________________
Ride Leader:  ____________________________
Speed/ Code:  1  2  3  4  a  b  c  d
Start location: ____________________________

Phone: __________________________________
Distance: ________________________________

Date/Start Time: ___________________________
RELEASE AND WAIVER OF LIABILITY, ASSUMPITON OF RISK, AND INDEMNITY AGREEMENT AND PARENTAL CONSENT AGREEMENT IN CONSIDERATION of being permitted to participate in any way in the Tacoma Wheelmen's Bicycle Club ("Club") sponsored Bicycling Activities ("Activity"), I for myself, my personal representatives, assigns, heirs, and next of kin:
1) ACKNOWLEDGE, agree, and represent that I understand the nature of Bicycling Activities and that I am qualified in good health, and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.
2) FULLY UNDERSTAND that (a) BICYCLING ACTIVITIES INVOLVE RISKS and DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, OR THE NEGLIGENCE OF THE 'RELEASES' NAMED BELOW there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time, and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPPONSIBILITY FOR LOSSES, AND DAMAGES I incur as a result of my participation in the Activity
3) HEREBY RELEASE, DISCHARGE, AND CONVENANT NOT TO SUE the CLUB, their administrators, directors, agents, officers, volunteers and employees, other participants, any sponsors, advertisers, and if applicable, owners and leasers of premises on which the ACTIVITY takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR OTHER DAMAGES ON MY ACCOUNT CAUSES OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite the RELEASE AND WAIVER OF RESPONSIBILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.
4) I AGREE to wear a helmet while participating in this Activity and to follow the rules of the road and all applicable laws and safe bicycling practices.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTHWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
5) If I am signing on behalf of a minor, I accept full responsibility for all medical expenses incurred as a result of the minor's participation. I agree to HOLD HARMLESS & INDEMNIFY the entities named above for any claims brought on behalf of the minor. 
_____________________________________________   _________________________
Signature: Ride leader or Event Coordinator     Address

Participants: ALL AGREE TO THE ABOVE RELEASE

  NAME (print legibly)   EMERGENCY NO.	    SIGNATURE (Parent or guardian if 
                                             participant is under 18)	

1. ___________________   _________________   _______________________________

2. ___________________   _________________   _______________________________

3. ___________________   _________________   _______________________________

4. ___________________   _________________   _______________________________

5. ___________________   _________________   _______________________________

6. ___________________   _________________   _______________________________

7. ___________________   _________________   _______________________________

8. ___________________   _________________   _______________________________

9. ___________________   _________________   _______________________________

10. __________________   _________________   ______________________________