REGISTRATION AND RELEASE
The Twelveth Great Yockatomac Trek
Yockatomac Trek 2010
Name: _________________________________ ____ Email Address: _______________________________________
Address: ___________________________________ Telephone: Day: (____)___________ Eve: (____)___________
City: __________________ State: ____ Zip: ______ Cell Phone: (____)__________ Carry on Trip? ___Yes ___No
Emergency Contact Name: _______________________________ Phone: (____) __________ Relationship: __________
□Over 18 yrs of age □Under 18 yrs of age: Age ___& accompanied by _______________ Relationship: __________
I have a roommate. Name: _____________________________________ Rooming together entire trip? ___________
Rooming together the following nights only: ______________________________________________________________
I would like assistance in finding a roommate: ___Yes ___No Gender: ________ For entire trip? ___Yes ___No
For the following nights only: _________________________________________________________________________
Do you wish to have your bike transported to Washington DC? ___Yes ___No
I will arrive in Washington DC (date/time) _________________ Via: (friend, Bus, Amtrak, etc.) ___________________
How could you be reached in Washington DC on Saturday June 19? __________________________________
GENERAL RELEASE AND INDEMNIFICATION
I, the above named participant, agree to participate in the 2010 Yockatomac Trek, a bicycle ride from Washington, DC to McKeesport, PA, beginning June 19, 2010 and ending June 27, 2010. I specifically RELEASE and DISCHARGE, on behalf of myself, my heirs, my personal representatives and assigns, the Allegheny Trail Alliance and the Yockatomac Trek, their affiliates and their agents, representatives, officers, directors, employees, successors, and assigns, members or any affiliate of any person or entity of them, from any and all liability, whether known or unknown, even though that liability may arise in whole or in part out of the negligence, omission, or carelessness on the part of persons or entities mentioned above. I further RELEASE and DISCHARGE the above said entities and persons from any and all actions, causes of action, damages, demands, injuries, and liabilities of any nature, including reasonable attorneys’ fees and interest, arising out of or in any manner connected with their involvement with my participation in the above referenced activity. I am a voluntary participant in this event, and in good physical condition. I agree to accept all responsibility for the risks, conditions and hazards which may occur whether known or unknown. Being fully aware of the risks, conditions, and hazards of bicycle riding, I HEREBY AGREE TO WAIVE, RELEASE AND DISCHARGE any and all claims for damages, personal injury, property damage, or death, which I may have or which may hereafter occur to me as a result of my participation in such activity against any person or entity mentioned above whether or not such injury or damage was foreseeable.
I further agree to forever hold HARMLESS AND INDEMNIFY, including reasonable attorney fees, all persons and entities identified above, generally or specifically, for any and all claims brought against them from any and all liability for personal injury, property damage, and/or death resulting in any way from my participation in the 2010 Yockatomac Trek.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, AND FURTHER AFFIRMS THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.
Signature:_____________________________________ Date:________________