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Allies Angel Ride

Sunday, August 25th 2013


All proceeds to benefit children of the Southern Tier including Whitney Point Preschool and Daycare 5K Run/Walk and Bicycle Ride
Events begin and end at: Hickories Park; 359 Hickories Park Road Pavilion 5; Owego, NY Events day registration starts at 8:00 a.m. Events begin at 9:00 a.m. Registration fee is $30 for pre-registration ending August 10th, includes t-shirt, streamers, water bottle and meal ticket. Additional meal tickets $10. Registration fee is $35 day of event and includes t-shirt (sizes may be limited), streamers, water bottle and meal ticket. Additional meal tickets $12.
Registration Form First Name ___________________________ Last Name ______________________________ Address _____________________________City__________________ State_________Zip_________ Email_______________________________________Phone____________________________ Gender (please circle) M / F Birth Date_______________ Age on Event Day_______

Emergency Contact: Name ______________________________Phone _________________ To guarantee a t-shirt your pre-registration must be received prior to August 10, 2013. Please Circle Adult Shirt Size: Please Circle Child Shirt Size: 5K Run/Walk Fee ($30) ____ S S M M L L XL XL XXL 3XL

25 Mile Bicycle Ride Fee ($30) ____

Kids Tricycle/Bicycle Rodeo (Free with registered adult) ____ or suggested donation $15 without registered adult. Additional meal tickets ______ ($10 each) Additional Donation _________ Please Make Checks Payable to: Allies Angels Mail Pre-Registration and Payment to: 50 Youngs Road Port Crane, NY 13833 I cannot attend Allie's Angels Ride, but I would like to donate and be a Friend of Allies Angels _________

Waiver and Release of Liability for 5K, Bicycle Ride, and Rodeo Participants: I, ________________________________, am a willing participant in a fundraising and awareness event in support of children of the Southern Tier in memory of Allison Elizabeth. As part of this event, I agree to assume all risks and to release and hold harmless Allies Angel Ride, its officers, workers, sponsors, officials, volunteers, including event leaders. I intend by this Waiver and Release to release, in advance, and to waive my rights and discharge all of the persons and entities mentioned above, from any and all claims for damages, for death, personal injury, or property damage which I may have, or which may hereafter occur to me as a result of my participation in this event. I understand and agree that this Waiver and Release is binding on my heirs and legal representatives. I understand that I am solely responsible for my health and safety, and I acknowledge that I am physically capable of participating in and completing this event. I hereby agree to allow Allies Angels the use of my name and likeness (event photos, videos) for any purpose related to advertising or promotion of the event and/or Allies Angels without obligation or liability to me. I have carefully read this Waiver and Release and fully understand its contents. If I am under the age of 18 years of age at the time of registration, my parents or legal guardian has completely reviewed this Waiver and Release, understands and consents to its terms, and authorizes my participation by his/her signature below. I am aware that this is a RELEASE OF LIABILITY and a contract between me and the persons and entities mentioned above, and I sign of my own free will. Signature _________________________________________________Date:______________ Printed Name ______________________________________ Parent/Guardian Signature _________________________________Date_______________ Printed Name_______________________________________ Please return this completed form along with the registration form and a check payable to: Allies Angels, 50 Youngs Road, Port Crane, NY 13833

***** A parent or guardian MUST be present for all children participating in the rodeo.

Allies Angel Ride


Sunday, August 25th 2013
All proceeds to benefit children of the Southern Tier including Whitney Point Preschool and Daycare Motorcycle Ride
Ride begins and ends at: Hickories Park; 359 Hickories Park Road Pavilion 5; Owego, NY Ride day registration starts at 8:00 a.m. Ride leaves at 9:00 a.m. Registration fee is $20 and includes streamers and meal ticket. Additional riders are $15, including meal ticket; additional meal tickets for non-riders are $10 by August 10, $12 day of event.
Registration Form First Name ___________________________ Last Name ______________________________ Address _____________________________City__________________ State_________Zip_________ Email_______________________________________Phone____________________________ Gender (please circle) M / F Birth Date_______________ Age on Event Day_______

Additional Rider: _______________________________________________________________ Emergency Contact: Name ______________________________Phone _________________

Optional: T-shirts are available for an additional $10, if registered by August 10 th, or $15 on the day of the event: Please Circle Adult Shirt Size: S M L XL XXL 3XL

Additional meal tickets ______ ($10 each) Additional Donation _________ Please Make Checks Payable to: Allies Angels Mail Pre-Registration and Payment to: 50 Youngs Road Port Crane, NY 13833 I cannot attend Allie's Angels Ride, but I would like to donate and be a Friend of Allies Angels _________

Waiver for Motorcycle Ride Participants: In consideration of being permitted to participate in any way in Allies Angel Ride, hereinafter called "The Ride", I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Allies Angels, its officers or agents from liability from any and all claims including the negligence of Allies Angels, its officers and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in The Ride. Assumption of Risks: Participation in The Ride carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, fractures of bones and/or limbs, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death. Indemnification and Hold Harmless: I freely agree to INDEMNIFY AND HOLD Allies Angels HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorneys fees brought as a result of my involvement in The Ride and to reimburse them for any such expenses incurred. Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of New York and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Permissions: Allies Angels has my permission to use my photograph, video and audio recordings, likeness, artwork, profile and/or story in this and future publications, web pages and other promotional materials produced, used by and representing Allies Angels. I understand the circulation of the materials could be worldwide and that there will be no compensation to me for this use. Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Signature _________________________________________________Date:______________ Printed Name ______________________________________ Please return this completed form along with the registration form and a check payable to: Allies Angels, 50 Youngs Road, Port Crane, NY 13833 Parent/Guardian Signature _________________________________Date_______________ Printed Name_____________________________________ ***** Minors under age 18 will only be allowed to participate in the motorcycle ride as a passenger*****