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REGISTRATION FORM
NAME_____________________________________
ADDRESS_________________________________
PHONE__________________________________
Waiver/Consent
I the undersigned, in consideration of my entry in the High Desert
Mountain Bike Poker Run, do certify that I am physically fit and
suitably trained to participate in said event. I agree to be bound
by all rules of the race and decisions of the officials. I hereby,
for myself, my child, my heirs, executors and administrators,
waive and release any and all rights and claims for damages I
or my child may have against Fossil Country Museum, the Kemmerer
BLM Field Office or on behalf of any organization in whose building
or grounds this activity is being held, and any instructors, directors,
or persons of these organizations from any liability or injuries
received or loss to person or property while participating in
any activity sponsored by Fossil Country Museum. I understand
that as a participant, I am not covered by Fossil Country Museum
or BLM insurance while traveling to or participating in this activity.
If the participant is a minor, I give my permission for his/her
participation in this activity and for the instructors/supervisors
to act on my behalf in case of a medical emergency.
Signature________________________________ Date_______________
Parent Signature _____________________________ (parent or guardian if under 18)