Cycling - Retreat Form - Grey

Cycling - Retreat Form - Grey

Stylish grey form to register for a retreat with sport activities. It includes a waiver and a signature field. Form Preview
  • Please fill the complete form below to secure your spot at this year's retreat September 12th - 14th
    • Linked Cycling Member Information  
    • Logistics  
    • Extras  
    • Sponsorship Need / Support  
    • Payments  
    • Click HERE to make payments through Paypal to Email:

      Be sure to select "Friends or Family" to avoid additional fees.

      Minimum of $100 deposit due to reserve your spot at the reatreat.

      Total payments are due by: September 1st 2014

      The paypal account has been set up in order to make budgeting payments leading up to the event.  Down payments can be accepted in part or in full.  Early payments are greatly appreciated so we pay necessary deposits and handle all necessary the early logistics.

    • Linked Retreat Leaders  

      Ministry             -  Ryan Damato       949-842-6160
      Race Team        -  Sean Smith          949-637-3782
      Mountain Biking  -  Paul Kuntzman     949-395-7214
      Road Cycling      -  Dr. Scott Vrzal      949-201-8166



                              -  James Aldrich       949-433-9084
                              -  Josh Kompa         949-315-9376

    • Waiver  
    • I acknowledge that this athletic event is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault.

      I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by a qualified medical person.

      I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers, in which I may participate and that it will govern my actions and responsibilities at said events.

      In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which might hereafter accrue to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS:

      Linked Cycling and Compass Bible Church

      Their directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by negligence of releases or otherwise.

      I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during this event.

      I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and assigns.

      The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under law.

    • Clear
    • Final Information  
    •  -  - Pick a Date
    • Payment instructions given after submitting this form.

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