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									       Eagle Rock cycling, United Cyclists of Jackson Hole, the Idaho Falls
Downtown Development Corporation, and historic downtown Idaho Falls present:

 SATURDAY, JULY 9                                                   TH


Event                   Start                                         Distance
Kids 4 and under        5:00 p.m. at corner of Shoup and A            About 1 block
Kids 5-9                5:05 p.m. at Great Harvest                    1 lap (about 0.65 miles)
Kids 10-14              5:15 p.m.                                     2 laps
                     Held under USA Cycling Non-competitive Fun Ride permit #2193.
       Any kind of bicycle/tricycle is fine, but helmets are required.
       There is no entry fee, but registration is required, and parents must sign the waiver.
       Pre-register by filling out the form and waiver on the reverse side and dropping it off at
        Idaho Mountain Trading, Great Harvest Bakery on A Street, or Bill’s Bike Shop on or
        before Friday, July 8. You can also register the day of the race at Great Harvest
        between 3:00 and 4:45 p.m.
       The first 200 kids to register receive a t-shirt, and all finishers receive a medal.
       For more information, contact Rob Van Kirk at 208-881-3407.
                          Non - Competitive (Excluding Gran Fondo) Event - 2011 USA Cycling Release Form and One-Day License Application
The following event release form has been approved by USA Cycling, Inc. If
                                                                 contractual representations and agreements. I ACKNOWL- registered for this event and that the use of blood boosting or
reproduced, it must be in a minimum of 10 point type and retain the exact same
                                                                 EDGE THAT CYCLING IS AN INHERENTLY DANGEROUS substances prohibited by Releasees’ rules would make me sub-
                                                                 SPORT AND FULLY REALIZE THE DANGERS OF PARTICI- ject to penalties including, but not limited to, disqualification and
              ONE-DAY PAYMENT INFORMATION                        PATING IN THIS EVENT, whether as a rider, official, coach, suspension. I agree to be subject to drug testing if selected, and
        CASH OR CHECK ACCEPTED (No Credit Cards)                 mechanic, volunteer, or otherwise, and FULLY ASSUME THE its penalties if I fail to comply with the testing or am found posi-
              Non-Competitive Event: $5 PER DAY                  RISKS ASSOCIATED WITH SUCH PARTICIPATION INCLUD- tive for the use of a banned substance.
                                                                 ING, by way of example, and not limitation: dangers associate-
Amount Paid _NA_____________________________________ ed with man made and natural jumps; the dangers of collision                       I agree, for myself and my Successors, that the above repre-
Event Date(s) ________________________________________ with pedestrians, vehicles, other riders, and fixed or moving                sentations are contractually binding, and are not mere recitals,
Authorized Personnel Initials ___________________________ objects; the dangers arising from surface hazards, including pot and that should I or my Successors assert a claim contrary to
                                                                 holes, equipment failure, inadequate safety equipment, use of what I have agreed to in this contract, the claiming party shall be
    PLEASE COMPLETE THE FOLLOWING INFORMATION                    equipment or materials provided by the event organizer and oth- liable for the expenses (including legal fees) incurred by the
                                                                 ers, THE RELEASEES’ OWN NEGLIGENCE, the negligence of Releasees in defending the claims. This contract may not be
                                                                 others and weather conditions; and the possibility of serious modified orally, and a waiver or modification of any provision
TODAY’S DATE _______________________________________
                                                                 physical and/or mental trauma or injury, or death associated with shall not be construed as a waiver or modification of any other
EVENT NAME Allan Butler Memorial Kid’s Fun Ride                  the event. For myself, my heirs, executors, administrators, legal provision herein or as a consent to any subsequent waiver or
EVENT DATE(S) July 9, 2011                                       representatives, assignees, and successors in interest (collec- modification. I consent to the release by any third party to
                                                                 tively “Successors”) I HEREBY WAIVE, RELEASE, DIS- Releasees and their insurance carriers of my name and medical
NAME _______________________________________________ CHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNI- information that may relate solely to any injury or death I may
ADDRESS____________________________________________ FY AND NOT TO SUE the Releasees and all sponsors, organ- suffer arising from the event. Every term and provision of this
CITY________________________ ST_______ ZIP ___________ izers and promoting organizations, property owners, law contract is intended to be severable. If any one or more of them
                                                                 enforcement agencies, public entities, special districts and is found to be unenforceable or invalid, that shall not affect the
PHONE ______________________ E-MAIL_________________ properties that are in any manner connected with this event, and other terms and provisions, which shall remain binding and
EMERGENCY CONTACT_______________________________                 their respective agents, officials, and employees through or by enforceable.
EMERGENCY CONTACT PHONE________________________                  which the event will be held, (the foregoing are also collectively
                                                                 deemed to be Releasees), FROM ANY AND ALL RIGHTS AND ________________________________________ __________
I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT, I AM CLAIMS INCLUDING CLAIMS ARISING FROM THE Signature of Entrant                                                                            AGE
SUE AND RELEASE FROM LIABILITY THE ORGAN-IZER OF EXTENT PERMITTED BY LAW, which I have or which may I am the parent or guardian of __________________(Child). My
THIS EVENT AND USA CYCLING, INC. (USAC), ITS hereafter accrue to me and from any and all damages which may Child is fit for the event, and I consent to my Child’s participation.
ASSOCIATIONS (THE UNITED STATES CYCLING FEDERA- be sustained by me directly or indirectly in connection with, or I HAVE READ AND I UNDERSTAND THE ABOVE CON-
TION (USCF), NATIONAL OFF ROAD BICYCLE ASSOCIA- arising out of, my participation in or association with the event, or TRACT. In consideration of allowing my Child to participate, I
TION(NORBA), NATIONAL COLLEGIATE CYCLING ASSOCIA- travel to or return from the event. I agree it is my sole respon- consent to the contract and agree that ITS TERMS SHALL
TION (NCCA), U.S. PROFESSIONAL RACING ASSOCIA- sibility to be familiar with the event course and agenda, the LIKEWISE BIND ME, MY CHILD, and our heirs, legal represen-
TION (USPRO), AND BMX ASSOCIATION (BMXA)), AND USA Releasees’ rules, and any special regulations for the event and tatives, and assignees. I HEREBY RELEASE AND SHALL
CYCLING DEVELOPMENT FOUNDATION (USACDF), AND agree to comply with all such rules and regulations. I under- DEFEND, INDEMNIFY AND HOLD HARMLESS THE
THEIR RESPECTIVE AGENTS, EMPLOYEES, VOLUN- stand and agree that situations may arise during the event which RELEASEES FROM EVERY CLAIM AND ANY LIABILITY that I
TEERS, MEMBERS, CLUBS, SPONSORS, PROMOTERS AND may be beyond the control of the Releasees, and I must contin- or my Child may allege against the Releasees (including rea-
AFFILIATES (COLLECTIVELY “RELEASEES”), AND THAT I ually ride and otherwise participate so as to neither endanger sonable legal fees and costs) as a direct or indirect result of
AM GIVING UP SUBSTANTIAL LEGAL RIGHTS. THIS myself nor others. I accept responsibility for the condition and injury or death to me or my Child because of my Child’s partici-
RELEASE IS A CONTRACT WITH LEGAL AND BINDING adequacy of my equipment, any equipment provided for my use, pation in the event, WHETHER CAUSED BY THE NEGLI-
CONSEQUENCES AND IT APPLIES TO ALL RACES AND and my conduct in connection with this event. I will wear a hel- GENCE OF THE RELEASEES OR OTHERS TO THE MAXI-
ACTIVITIES ENTERED AT THE EVENT, REGARDLESS met which satisfies the requirements of the Releasees’ Racing MUM EXTENT PERMITED BY LAW. I PROMISE NOT TO SUE
WHETHER OR NOT LISTED ABOVE. I HAVE READ IT Rules or Regulations and that can protect against serious head RELEASEES on my behalf or on behalf of my Child regarding
CAREFULLY BEFORE SIGNING, AND I UNDERSTAND WHAT injury, and assume all responsibility and liability for the selection any claim arising from my Child’s participation in the event.
IT MEANS AND WHAT I AM AGREEING TO BY SIGNING.                   of such a helmet and any modifications or attachments made
  In consideration of the issuance of a license to me by one or  thereto. I have no physical or medical condition which would
more Releasees or the acceptance of my application for entry in  endanger myself or others if I participate in this event, or would ___________________________________________________
the above event, I hereby freely agree to and make the following
                                                                 interfere with my ability to safely participate in this event. I Signature of Parent or Non-Competitive Event Release.qxp Rev 11/10
                                                                                                                                    M:/2011 Membership Forms/2011
                                                                 understand that drug testing may be conducted for athletes

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