Enclosed: Payments Enclosed:

Size: px

Start display at page:

Download "Enclosed: Payments Enclosed:"

Gwenda Cannon
5 years ago
Views:

NICA Expedition Registration Form www.nationalmtb.org Completed Registration Form Signed check Enclosed: Payments Enclosed: Deposit (fully refundable before July 1) $ 100.

1 NICA Expedition Registration Form Completed Registration Form Signed check Enclosed: Payments Enclosed: Deposit (fully refundable before July 1) $ Expedition Fee (less deposit) $ Late Fee (registration received after July 1) $ Total Payment Enclosed: Make checks payable to: NICA Mail form/payment to: NICA Expedition.

2 NICA Expedition Registration Form Personal Information First Name: Last Name: School: Team: Date of birth: Grade: Gender: M F Address: City: State: Zip: Athlete's Cell Phone: Home Phone: Parent Contacts Parent/Guardian 1: Cell phone: of Parent/Guardian 1: Parent/Guardian 2: Cell phone: of Parent/Guardian 2: Work Phone of a Parent/Guardian: Emergency Contacts Emergency Contact 1 Name: Phone: Emergency Contact 2 Name: Phone: Health Insurance Provider: Policy Number:

3 1 AgreementtoParticipateand ReleaseofLiability The undersigned hereby acknowledge that by signing this Agreement, they are assuming risks and agreeingtoindemnify,nottosue,andagreeingtoreleasefromliabilitythenationalinterscholasticcycling Association(hereinafter"NICA"),it'schapters,subsidiaries,affiliates,officers,officials,agents,employees, coaches,leaders, instructors,volunteers,agents,sponsoringagencies,sponsors,members,participants,clubs,teams,riders andifapplicable,ownersandlessor'sofpremisesusedforactivities(hereinaftercollectivelyreferredtoas "Releasees").Itisfurtherunderstoodthattheundersignedaregivingupsubstantiallegalrights. Inconsiderationofmyvoluntaryparticipationinmountainbikingevents,theundersignedvoluntarilymakesthe followingagreements.theundersignedacknowledgethatthesportofcycling,specificallymountainbicycling,is aninherentlydangeroussport,includingbutnotlimitedtodangersassociatedwithmanmadeobstaclesornatural surface hazards, trees, logs, vegetation, water, pot holes, rocks, cold weather, extreme heat, rain, other bicycles, other riders, pedestrians, vehicles, fixed or moving objects, equipment failure, inadequate safety equipment, and use of equipment or materials provided. Safety equipment includes the use of a safety helmet, which the undersignedhaveselectedandwhichsatisfiestherequirementsofnica,toprotectagainstseriousheadinjury. The undersigned ACKNOWLEDGE AND FULLY ASSUME THE RISKS associated with participating in activities, as listed above and including the Releasees own negligence and the negligence of others. The undersigned fully understand that mountain biking activities include the potential for serious physical injury, permanent paralysis and/or mental injury, disability or death, loss or damage to person or property associated with presence or participationintheactivity.theundersignedunderstandthatparticularskills,equipmentandpersonaldiscipline mayreducetherisks,butthatriskofseriousinjuryexists. Therisksinclude,amongotherthings:thedangersofcollisionwithpedestrians,vehicles,otherriders,andfixed or moving objects; the dangers arising from surface hazards, including trail irregularity, equipment failure, inadequate safety equipment, use of equipment provided by NICA or others; dangers associated with man made and natural jumps and stunts; motor vehicle accidents; the releases own negligence; the negligence of others; weather conditions; the possibility of serious physical and/or mental trauma or injury, or death associated with thisprogram;slippingandfalling;fallingobjects;waterhazards;drowning;exhaustion;exposuretotemperatureand weatherextremeswhichcouldcause:hypothermia,hyperthermia(heatrelatedillnesses),heatexhaustion,sunburn, dehydration;andexposuretopotentiallydangerouswildanimals,insectbites,andhazardousplantlife. On behalf of self, spouse, heirs, executors, administrators, legal representatives, assignees, and successors in interest (hereinafter collectively Successors ), the undersigned hereby RELEASE, INDEMNIFY AND HOLD HARMLESS the Releasees. The undersigned hereby waive any and all rights and claims, including claims arising fromthereleasees ownnegligence,whichtheundersignedhas,orwhichmayhereafteraccrue,andfromanyand alldamageswhichmaybesustainedbytheundersigneddirectlyorindirectlyinconnectionwith,orarisingoutof, participationinorassociationwiththeevents,includinganyactivitiesincidentalthereto,whereverorhoweverthe samemayoccur. The undersigned participant agrees that it is their sole responsibility to be familiar with the event course and agendaandthereleasees rulesandanyspecialregulationsfortheevent.theundersignedagreetocomplywith Releasees rules and regulations/stated and customary terms and conditions for participation. The undersigned participant agrees to ride and otherwise participate so as to neither endanger myself nor others. If the undersigned participant observes any unusual significant hazard during my presence or participation, the participantwillremovethemselvesfromparticipationandbringtotheattentionofnica,saidhazardimmediately. The undersigned participant accepts full responsibility for the condition and adequacy of my equipment or any equipment provided for use. The undersigned participant agrees to wear a helmet, which satisfies the requirements of Releasees racing rules and regulations, the purpose of which is to protect against serious head injury,andtheundersignedassumeallresponsibilityandliabilityfortheselectionofsuchahelmet.

4 2 TheundersignedparticipantherebycertifiesthatIhavenophysicalormedicalconditionwhichwouldendanger myselforothers,orinterferewithmyabilitytosafelyparticipateinthisevent. Theundersignedagree,forselfandsuccessors,thattheaboverepresentationsarecontractuallybinding,andare notmererecitals.theundersignedunderstandthatifclaimsaremadeagainstreleaseesthattheundersignedwill beresponsibleforanycostsandfeesincurredbyreleaseesindefendingtheclaims. ThisAgreementmaynotbemodifiedinanyway,andnotorally.ThisAgreementshallbeeffectiveforinjuriesnow orwhichmayhereinafteroccurinthefuture,whetherknownorunknown. The undersigned hereby agrees to hold harmless any and all Releasees, from any liability for ordinary negligence. TheundersignedherebyexpresslyagreethatthisReleaseandWaiverisintendedtobeasbroadandinclusiveas permittedbythelawsofthestateofcaliforniaandthatifanyportionhereofisheldinvalid,itisagreedthatthe balanceshall,notwithstanding,continueinfulllegalforceandeffect. I have read the above carefully before signing and understand its terms, including giving up substantial legalrights. Dated SignatureofParticipant PrintedName DateofBirth HomePhone# Team/School(listbothiftheyaredifferent) League CONSENTANDRELEASEOFPARENTORLEGALGUARDIAN Iamtheparentorlegalguardianof (Participant).Mychildisfitforparticipationinthesportof mountain biking. I have read and understand the above Agreement, and agree to the Release of Liability as set forth above. In consideration of allowing my child to voluntarily participate, I consent to the Agreement and its termsshalllikewisebebindingonme,mychild,myheirs,legalrepresentativesandassignees.ihereby,formyself, my child and my heirs, HEREBY RELEASE, INDEMNIFY, and HOLD HARMLESS the Releasees, whether or not arisingfromthenegligenceofthereleasees. I hereby release for myself and my child, and shall defend, indemnify and hold harmless the Releasees from any andallclaimsofliabilitythatiormychildmayallegeagainstreleasees,(includingreasonableattorneysfeesand costs), as a direct or indirect result of injury or death due to my child s participation in the activities offered by Releasees,whethercausedbythenegligenceoftheReleaseesorothers. Ihavereadtheabovecarefullybeforesigningandunderstandthiswaiver. Dated SignatureofParentorLegalGuardian PrintedName

5 3 Media,PhotoandData ReleaseForm Tobefilledoutbytheparent/legalguardian.Pleasereadandcompletetheinformationbelow.Please checktheappropriateboxesbelow. Iamtheparent/guardianof andhaveregisteredhim/herfor2011 NorCalLeagueraceseason. PermissiontouseMediaandPhotos YES,IgivemypermissionforNICA,theWashingtonLeagueandoutsidemediaagents(newspapers, television,etc.)totakephotographs,video,andotherwisedocumentmychildinvolvedintheactivitiesof thisprogram.igivepermissionforanyphotographsorvideomaterialofmychildtobeusedinpublicity abouttheprogramandorganization(website,promotionalmaterials,newspaper/magazinearticles, etc.). NO,IdonotgivemypermissionforNICA,theWashingtonLeagueandoutsidemediaagents (newspapers,television,etc.)totakephotographs,video,andotherwisedocumentmychildinvolvedin theactivitiesofthisprogram.idonotgivepermissionforanyphotographsorvideomaterialofmychild tobeusedinpublicityabouttheprogramandorganization(website,promotionalmaterials, newspaper/magazinearticles,etc.) PermissiontoParticipateintheCollectionofData YES,Igivemypermissionformyson/daughtertoparticipateinNICAandWashingtonLeague surveys,bothonlineandinprint,forthepurposeofcollectinginformationabouttheprogram, participants,andtheimpactmountainbikingandtheleagueishavingonhighschoolyouth. NO,Idonotgivemypermissionformyson/daughtertoparticipateinNICAandWashingtonLeague surveys,bothonlineandinprint,forthepurposeofcollectinginformationabouttheprogram, participants,andtheimpactmountainbikingandtheleagueishavingonhighschoolyouth. Parent/GuardianSignHere PrintName Date

6 4 MedicalReleaseForm Please read and check off the following, fill in and sign where indicated. I, haveregisteredmyson/daughter forthe[seasonyear] [League]racingseries. Myson/daughterisingoodphysicalandmentalhealthandisabletoparticipatefullyinallNICA races.she/hehasnomedicalconditions. Myson/daughterhasthefollowingmedicalcondition(s).(Pleaseprovidemoreinformationonthe backofthissheetifnecessary). Myson/daughterhasasthmaandwillhaveaninhalerwithhim/her.Pleaseprovidemore informationifnecessary: Myson/daughterisonthefollowingprescriptionmedications.Pleaseindicateifshe/heisorisnot abletoself administerthesemedicationswhileatcamp,ifapplicable. IauthorizetheNICA/LeaguestafftogivemychildIbuprofenintheeventshe/heneedsit. HealthInsuranceCarrier: Group#: Policy# EmergencyContact#1,Name TelNo. EmergencyContact#2,Name TelNo. OnthisformIhaveprovidedcomprehensiveandaccuratemedicalinformationaboutmyson/daughter tonica.iftheleagueisnotabletoreachmyselfortheemergencycontactsihaveprovided,iauthorize NICAstafftodrivemyson/daughtertothenearestemergencyroomtoreceiveemergencymedical treatment. Signhere Printname Date

7 5 TrailEtiquette& CodeofConduct Pleasereadtheinformationbelow,thenchecktheappropriateboxes(page2),signandreturnto NICA. 1.RidePredictably.Whenridingwithothersalwaysrideinastraight,steady,andpredictablemanner.Swerving ontosidewalks,bermsorjumpsisunacceptableandwillresultinstrictdisciplinefromacoachorleaguedirector. Thereisnojumpingonteamrides;keepbothtiresontheground. 2.WearaHelmetatAllTimes.Undernocircumstancesshouldyoubeonyourbikewithoutahelmetfastenedto yourhead,duringpracticeoratraces.leaguememberswillbedisqualifiedforridingwithoutahelmet this includeswhileridingtrainerstowarmup(ifyourlegisoverbike,yourhelmetbuckledisonhead). 3.AlwaysYield.Evenifattimesitseemsinconvenient.Beingsensitivetohowothersperceiveyouwillassurea positiveimageforyoursportandminimizetherestrictionsthatfollowconfrontationsandnegativeencounters. Rememberthatbicyclesinthebackcountrycanbeanunwelcomeexperienceforhorsesandhikers.And,yieldto uphillriderswhenridingdownatrail. 4.PasswithCare.Alwaysbekindandpolite.GoverySLOW goslowenoughtosay hello,andforothertrail userstosay hello back.alwaysstopatareasonabledistanceandaskforpassinginstructionsfromhorseriders. Horsescanbeeasilyspookedbybicyclesandmustberespected. 5.StayonTrails.Ridingoffthedesignatedtraildamagesmeadowsandotherfragileecosystems.Nevercut switchbacksasthisaccelerateserosion.bewarethetypesofsoilyouareridingon.beconscientiousofthetypeand conditionofthesoilsyouareridingon.donotwidenexistingtrailstoavoidmud;rideorwalkthroughdeepmud sectionsandpuddles. 6.RideOnlyonAuthorizedTrails.Checkwithlocalauthoritiesregardingopentrailsandconditions,andwith landownersregardingprivatelandaccess.stayofftrailsthatareclosedtobicycles.beawarethatbicyclesarenot permittedinareasprotectedasstateorfederalwilderness. 7.ControlYourSpeed.Safespeedsarerelativetoterrain,lineofsite,andyourexperienceasarider.Beableto stopsafelywithoutskiddinginthedistancethatyoucanseeahead.approachswitchbacksandturnsin anticipationofsomeonecomingaroundthebend,andadheretopostedspeedlimits. 8.Don tbeashow Off.Showingofforridingrecklesslyinfrontofotherswillnotbetolerated. 9.RespectWildlifeandLivestock.Donotfrightenanimals.Closegatesasyoupassthrough,unlessitappears obviousthattheyhavebeenintentionallyleftopen. 10.DoNotLitter.Packoutwhatyoupackin.Makeeveryefforttopickupotherpeople'strash;itwillmakeyou feelrealgood! 11.BePrepared.Youshouldbepreparedtofixbasicbicyclemechanicalssuchasflattires,chainbreaks,and conductsimplebikeadjustments.carryandknowhowtousebasictools,includingtirelevers,asparetube,and inflationdevice.expectweatherchangesanddressappropriately. 12.PlanAhead.Leavewordwhereyouplantogo,whenyouplantoreturn,andfollowyourplan. 13.MinimizeImpacts.Bringbackpicturesandmemoriesonly.

8 NICAStudentAthleteCodeofConductChecklist Pleasereadandchecktheboxbeforeeachitem: SAFETY Iwillalwaysridewithinmyabilityandnottakedangerousrisks Iwillalwayswearappropriatesafetygear: Iwillneverridewithoutahelmet. Iwillwearproperglovesandclothing. Iwillwearprotectiveeyewear. Iwillcheckmybrakesandbikeconditionbeforeeachride: Iwillnotrideanunsafebicycle. Iwillneverridealoneinisolatedareas. IwillalwaysletsomeoneknowwhereIamriding,whenIplantoreturn,andsticktotheplan. Iwillbringproperhydrationandnutritiononeveryride. Iwillbringappropriatetoolsandparts,suchasasparetubeorpatchkit,tirelevers,andinflation device. Iwillnotrideterrainoratspeedswhichareunsafeorbeyondmytechnicalability. Iwillnotrideinunsafeconditions: Excessiveexposuretodropsandfalls. Unsafeweatherconditionssuchaslightning,flashfloods,extremeheatorcold. Onwashed outtrails. RESPECT Regardingothers,Iwillrespectmyteammates,competitors,andotherpeopleonthetrail: Iwillnevertrashtalk,insultoruseinappropriatelanguagewhileonamountainbike. Iwillmoveasidetoallowsafepassingwhenafastercompetitorismovingbyme. WhenpassingfrombehindIwillannouncemypresenceandintentionandspecifypassingside. IwillalwaysdomybestwhenracingwhetherIamaheadorbehindasasignofrespecttomy competitorsandmyself. Iwillalwaysridewithcourtesy,whetherracingortraining. Iwillprovideappropriatesafespacingbetweenmyselfandcyclistsandtheirbikes. Iwillfollowtherulesofrightofway: Stoporslowdownwhenapproachinganequestrian,hikerordogwalker. Providerightofwaytopedestriansandequestrians. Stopandaskforpassinginstructionsfromequestrians.Ishouldneverpassahorsewithoutthe horseriderknowingi mthereandhavinggivenpermissiontopass. Regardingtrails,Iwillrespecttheland: Iwillneverlitterorleavetrashonthetrail. Iwillrideonlyondesignatedandlegaltrailsandroutes. Iwillpickuptrashwheneverpossiblewhenriding. Iwilllearntobrakecorrectlytominimizetrailerosion. Iwillnotrideontrailswhentheweatherandsurfaceconditionswillcausedamage. Iwillnotbuildtrailswithoutfullpermissionandpermitsfromthelandowner/manager. IunderstandandwillfollowtheNICALeaguerulesandstandards.Ialsounderstandthatfailuretodo somayleadtomysuspensionorexpulsionfromleagueactivities. StudentAthleteSignHere PrintName Date 6

2015 Winter Rider Clinics

2015 Winter Rider Clinics 34504 Collier Falls Court Temecula, CA 92592 (818) 415-1133 www.socaldirt.org SoCal winter rider clinics for 2015 are focused on newer riders who may not have raced before to