Allies Angel Ride

Saturday, May 31, 2014

All proceeds to benefit children and family of the Southern Tier of NY
Events begin and end at: Hickories Park; 359 Hickories Park Road, Pavilion 5, Owego, NY Childrens Bicycle/Tricycle Rodeo
Childs Name ________________________________________________________ Parents Name _______________________________________________________ Address _____________________________ City__________________ State _________ Zip _________ Email_______________________________________Phone____________________________ Gender (please circle) M / F Birth Date_______________ Age on Event Day_______

Emergency Contact: Name ______________________________Phone _________________ ***To guarantee a 2014 T-shirt your pre-registration must be received prior to May 3rd, 2014*** Please Circle Child Shirt Size: S M L XL

Registration is FREE with a registered adult participant; Donations are appreciated for those whose parents are not participating. Pizza will be provided to all Rodeo participants; Additional meal tickets ______ ($10 each)

Please Make Checks Payable to: Allies Angels Mail Pre-Registration and Payment to: 50 Youngs Road Port Crane, NY 13833

I cannot attend Allie's Angels Ride, but I would like to donate and be a Friend of Allies Angels _________

**** A parent or guardian must be present for your child to participate ****

Waiver and Release of Liability for Rodeo Participants: I, ________________________________, am a willing participant in a fundraising and awareness event in support of children of the Southern Tier in memory of Allison Elizabeth. As part of this event, I agree to assume all risks and to release and hold harmless Allies Angel Ride, its officers, workers, sponsors, officials, volunteers, including event leaders. I intend by this Waiver and Release to release, in advance, and to waive my rights and discharge all of the persons and entities mentioned above, from any and all claims for damages, for death, personal injury, or property damage which I may have, or which may hereafter occur to me as a result of my participation in this event. I understand and agree that this Waiver and Release is binding on my heirs and legal representatives. I understand that I am solely responsible for my health and safety, and I acknowledge that I am physically capable of participating in and completing this event. I hereby agree to allow Allies Angels the use of my name and likeness (event photos, videos) for any purpose related to advertising or promotion of the event and/or Allies Angels without obligation or liability to me. I have carefully read this Waiver and Release and fully understand its contents. If I am under the age of 18 years of age at the time of registration, my parents or legal guardian has completely reviewed this Waiver and Release, understands and consents to its terms, and authorizes my participation by his/her signature below. I am aware that this is a RELEASE OF LIABILITY and a contract between me and the persons and entities mentioned above, and I sign of my own free will. Signature _________________________________________________Date:______________ Printed Name ______________________________________ Parent/Guardian Signature _________________________________Date_______________ Printed Name_______________________________________ Please return this completed form along with the registration form and a check payable to: Allies Angels, 50 Youngs Road, Port Crane, NY 13833