Dayton Right to Life Society

2017 ND2UD Ride for Life Registration

ND2UD Ride

Country*
State / Province*
Address*
City*
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Email*
Confirm Email*
Phone*

Rider Type and T-Shirt Size

Quantity
Price
Total
Single Rider

Registering an individual rider. $200 registration fee includes meals, lodging, and t-shirt.

X
$
200.00=
$
0

Family 3+ Riders

Registering a family of 3 or more riders. $500 per family. Registration fee includes meals, lodging, and t-shirts.

X
$
500.00=
$
0

Student Rider (High School/College)

Registering a high school or college student rider. $100 registration fee includes meals, lodging, and t-shirt. Student must raise an additional $100 in pledges.

X
$
100.00=
$
0

DAY Rider

Registering a one-day rider. $75 registration fee includes meals, lodging, and t-shirt. DAY Rider can choose which one day he/she wishes to ride.

X
$
75.00=
$
0

Jerseys

Available for purchase. Select sizes below. *JERSEY PURCHASE DEADLINE: JUNE 23, 2017*

X
$
70.00=
$
0

Final Total:
$
0
Date of Birth
Rider #2 Name
Rider #2 Date of Birth
Rider #3 Name
Rider #3 Date of Birth
Additional Rider Information: If registering more than 3 riders, enter Names, T-Shirt Sizes, Dates of Birth, and Jersey Sizes (if purchasing) here.

Waiver

Release of Liability/Waiver:

In consideration of the acceptance of my entry and being allowed to participate or volunteer for the ND2UD Ride for Life (a one to four day event) sponsored by Dayton Right To Life Society, I, the undersigned, acknowledge, appreciate and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis, and death, and while particular skills, equipment and personal discipline may reduce this risk, the risk of serious injury does exist; and

2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of Dayton Right To Life Society immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless Dayton Right To Life Society, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity (“Releasees”), with respect to any and all injury, disability, death or loss or damage to person or property associated with my presence or participation, whether arising from negligence of the releasees or others, to the fullest extent permitted by law.

 

Safety helmets are required for all riders. Headphones for riders are not allowed in this event.

 

I grant Dayton Right To Life Society specific permission to reproduce, publish, circulate, copyright or use any and all photographs and/or video (and use of name) of me and/or my family taken at the ND2UD Ride for Life. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

 

*If you are registering more than one rider, each additional rider will need to sign a paper waiver the day of the event at check-in.*

Waiver Electronic Signature
Date

Parent/Guardian Waiver

For Parents/Guardians or Participants of Minority Age (Under age 18 at time of registration):

This is to certify that I, as parent/guardian with legal responsibility for this participant/ volunteer, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from the negligence of the releasees, to the fullest extent permitted by law.

Parent/Guardian Waiver Electronic Signature
Date of Parent/Guardian Signature

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

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