Completely fill out the Race Release Form (Pg. 2)
Mail Release Form and Check to:
331 Promotions
Attn: Dustin Clouse
282C Canterbury Lane
Medina, Oh. 44256
Make Check payable to 331 Promotions
Pricing:
Big Valley Race at Camp Manatoc:
All Juniors 18 & Under - $15.00
All Women 19 & Above - $20.00
All Men 19 & Above- $35.00
Race Entry and Release Form
331 PROMOTIONS LLC. (Ohio Limited Liability Company)
Please accept my entry in the race/race series. I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT, I AM RELEASING
331 Promotions LLC, Toad Promotions (Property Owner), United States of America, US Army Corps of Engineers, State of Ohio:
Findley State Park, West Branch State Park (Property Owner), Great Trail Council – Boy Scouts of America (Property Owner), City
of Medina (Property Owner), J. Taylor (Property Owner), City of Akron, Marathon Charitable Corporations, Department of
Natural Resources AND THEIR RESPECTIVE AGENTS, EMPLOYEES, MEMBERS, SPONSORS, PROMOTERS AND AFFILIATES
(HEREINAFTER KNOWN COLLECTIVELY AS THE “RELEASEES”) FROM LIABILITY. THIS ENTRY BLANK AND RELEASE IS
A CONTRACT WITH LEGAL CONSEQUENCES. I HAVE BEEN ADVISED TO READ IT CAREFULLY BEFORE SIGNING.
In consideration of the Releasees issuance of a license to me or the acceptance of my application for entry in the above event, I hereby freely
agree to and make the following contractual representations and agreements. I acknowledge that cycling is an inherently dangerous sport and
fully realize the dangers of participating in a bicycle race and FULLY ASSUME THE RISKS ASSOCIATED WITH SUCH
PARTICIPATION INCLUDING, by way of example and not limitation, the following: The dangers of collision with pedestrians, vehicles,
other racers, and fixed or moving objects; the dangers arising from surface hazards, equipment failure, inadequate safety equipment, THE
RELEASEES’ OWN NEGLIGENCE, and weather conditions; and the possibility of serious physical and/or mental trauma or injury
associated with athletic cycling competition. For myself, my heirs, executors, administrators, legal representatives, assignees, and successors
in interest (collectively “Successors”) I HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO
INDEMNIFY AND NOT TO SUE the Releasees and the sponsors of this event, the organizer and any promoting organizations, property
owners, law enforcement agencies, all public entities, special districts and properties, and their respective agents, officials, and employees
through or by which the events will be held, (the foregoing are also collectively deemed to be Releasees), FROM ANY AND ALL CLAIMS
INCLUDING CLAIMS ARISING FROM THE RELEASEES’ OWN NEGLIGENCE, which I have or which may hereafter accrue to
me, and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation
in or association with the event, or travel to or return from the event. I agree it is my sole responsibility to be familiar with the race course,
the Releasee’s rules, and any special regulations for the event. I understand and agree that situations may arise during the race which may be
beyond the immediate control of the race officials or organizers, and I must continually ride so as to neither endanger myself or others. I
accept responsibility for the condition and adequacy of my competition equipment. I will compete wearing a helmet which satisfies the
requirements of the Releasees Racing Rules or Regulations and that can protect against serious head injury, and assume all responsibility and
liability for the selection of such helmet. I have no physical or medical condition which to my knowledge, would endanger myself or others if
I participate in this event, or would interfere with my ability to participate in this event.
I agree, for myself and my successors, that the above representations are contractually binding, and are not mere recitals, and that
should I or my successors assert my claim in contravention of this agreement, the asserting party shall be liable for the expenses (including
legal fees) incurred by the other party or parties in defending, unless the other party or parties are finally adjudged liable on such claim for
willful and wanton negligence. This agreement may not be modified orally, and a waiver of any provision shall not be construed as a
modification of any other provision herein or as a consent to any subsequent waiver or modification. Every term and provision of this
agreement is intended to be severable. If any one or more of them is found to be unenforceable or invalid, that shall not affect the other terms
and provisions, which shall remain binding and enforceable.
Name (Please Print Clearly for Race Results) __________________________________________________________________________
Birth Date ____/_____/____________Age(As of 12/31/10) ______ Street_______________________________________________
City _________________________________ State ________________ Zip ____________ Phone # (______)_________________
E-Mail _________________________________________ please keep me informed - add my email to your announcement list
Who to notify in case of emergency ___________________________________________Phone # (______)____________________
circle correct answer
Category: ( Expert / Sport / Novice ) Gender: M | F Divisions: (Circle age group)
Sponsors____________________________________________________
Signature of entrant: _________________________________________________________ Date __________________
CONSENT AND RELEASE OF PARENT OR GUARDIAN
I am the parent or guardian of _________________________________ (hereinafter “child”). I hereby state that my child is fit for the race
and I consent to my child’s participation. I HAVE READ AND I UNDERSTAND THE ATHLETE’S ENTRY FORM AND RELEASE
AGREEMENT. In consideration of allowing my child to participate, I consent to the release and agree that ITS TERMS AND
CONDITIONS SHALL LIKEWISE BIND ME, MY CHILD, MY HEIRS, LEGAL REPRESENTATIVES AND ASSIGNS. I
HEREBY RELEASE AND SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM EVERY CLAIM,
DEMAND AND LIABILITY that I or my child may allege against the Releasees (including reasonable attorney fees or costs) as a direct or
indirect result of injury to me or my child because of my child’s participation in the event WHETHER THE SAME BE CAUSED BY THE
NEGLIGENCE OF THE RELEASEES OR OTHERS. I promise not to sue the Releasees on my behalf or on behalf of my child
regarding any claim arising from my child’s participation in the Race.
Signature of parent/guardian: _________________________________________________ Date _________________
- Junior/18 & under
- Senior/19-29
- Master/30-39
- Master/40-49
- Master/50+