Bikes in Your Blood Event Registration

Participant Registration Form

Participant Registration Form
Participant Information (All Cyclist 16 and Older)
Participant Name

First NameLast Name
Birth Date

MonthDayYear
Email
example@example.com
Add a Youth Rider (up to age 15)
Mobile Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.
Please select a T-shirt size
Informed Consent and Acknowledgement

I know that bike riding is a potentially hazardous activity. I should not ride unless I am medically able and properly trained. I assume all risks associated with participating in this event including, but not limited to, falls, contact with other participants, the effects of weather including high heat/humidity, cold, traffic, road conditions, getting lost, all such risks being know and appreciated by me. Having read this waiver, and knowing these facts and considerations of your accepting my entry, I, for myself, and anyone entitled to act on my behalf, waive and release, the Nevada Chapter of the National Hemophilia Foundation, City of Henderson, City of Boulder City, Bureau of Reclamation, the United States of America and National Park Service Lake Mead Recreation Area, and all other sponsors, representatives and successors from all claims of liabilities of any kind arising out of my participation in this event.
Boulder City Waiver

The undersigned, as a participant in the Bikes in Your Blood Cycling Event, an activity taking place at a Boulder City Facility, the undersigned, as a participant or legal guardian of the participant in the listed activity, do understand that, in consideration of the Park and Recreation Department, I do release them, their officers, agents or employees from all liability demands or claims for loss, damage, or injury resulting from participating in the mentioned activity, as there is no insurance provided. I recognize and understand that the described activities require that I be in good health. I warrant and declare that the participant is in good health. If the participant is a minor, I also give my consent for his/her participation in the activity, and for any necessary emergency medical treatment.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date