WAIVER OF LIABILITY: I fully assume and understand the risks of participation in an open
course ride including death or injury due to vehicles, falls, collisions, actions by other
participants or spectators, actions by hostile humans or animals, uneven pavement,
obstructions to provide medical attention at my expense should I appear in need. For
injuries I sustain, including death, I agree to save and hold harmless Washington County,
the Washington Community Y, local government, law enforcement personnel, volunteers,
event staff, supplies, contractors, and anyone else connected with the organization of this
event, from any claim or lawsuit that may be brought at anytime by me, my family estate,
heirs or assigns, arising from my participation in this event or the instructions I received.
WAIVER OF PUBLICITY: I agree that images taken of me during this event may be used in
any legal manner without payment to me. I have read and understand the terms of this
document and pay my entry fee in exchange for the privilege of participating under the
conditions of the event, including weather.
Signature ____________________________________________________________________
Signature of parent or guardian if under 18 ________________________________________
Emergency Contact (name)_____________________________________________________
(phone number)______________________________________________
Please send a separate registration form for each registrant.
Send your completed registration form(s) and fee to:
Washington Community Y
121 E Main St.
Washington, Ia. 52353
ATTN: Y to Y Bike Ride
course ride including death or injury due to vehicles, falls, collisions, actions by other
participants or spectators, actions by hostile humans or animals, uneven pavement,
obstructions to provide medical attention at my expense should I appear in need. For
injuries I sustain, including death, I agree to save and hold harmless Washington County,
the Washington Community Y, local government, law enforcement personnel, volunteers,
event staff, supplies, contractors, and anyone else connected with the organization of this
event, from any claim or lawsuit that may be brought at anytime by me, my family estate,
heirs or assigns, arising from my participation in this event or the instructions I received.
WAIVER OF PUBLICITY: I agree that images taken of me during this event may be used in
any legal manner without payment to me. I have read and understand the terms of this
document and pay my entry fee in exchange for the privilege of participating under the
conditions of the event, including weather.
Signature ____________________________________________________________________
Signature of parent or guardian if under 18 ________________________________________
Emergency Contact (name)_____________________________________________________
(phone number)______________________________________________
Please send a separate registration form for each registrant.
Send your completed registration form(s) and fee to:
Washington Community Y
121 E Main St.
Washington, Ia. 52353
ATTN: Y to Y Bike Ride