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StartSelection:0000000199 EndSelection:0000006164 In consideration of the issuance of a license to me by one or more Releasees or the acceptance of my application for entry in the above event, I hereby freely agree to and make the following contractual representations and agreements.
I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT, I AM ASSUMING RISKS, AND AGREEING TO INDEMNIFY, NOT TO SUE AND RELEASE FROM LIABILITY THE ORGANIZER OF THIS EVENT, USA CYCLING, INC. (USAC), USA CYCLING DEVELOPMENT FOUNDATION (USACDF), AND THEIR RESPECTIVE AGENTS, INSURERS, EMPLOYEES, VOLUNTEERS, MEMBERS, CLUBS, OFFICIALS, SPONSORS, EVENT DIRECTORS, LOCAL ASSOCIATIONS, AND AFFILIATES (COLLECTIVELY “RELEASEES”), AND THAT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS. THIS RELEASE IS A CONTRACT WITH LEGAL AND BINDING CONSEQUENCES AND IT APPLIES TO ALL RACES AND ACTIVITIES ENTERED AT THE EVENT, REGARDLESS WHETHER OR NOT LISTED ABOVE. I HAVE READ IT CAREFULLY BEFORE SIGNING, AND I UNDERSTAND WHAT IT MEANS AND WHAT I AM AGREEING TO BY SIGNING.
I ACKNOWLEDGE THAT CYCLING IS AN INHERENTLY DANGEROUS SPORT AND FULLY REALIZE THE DANGERS OF PARTICIPATING IN THIS EVENT, whether as a rider, official, coach, mechanic, volunteer, spectator, or otherwise, and FULLY ASSUME THE RISKS
ASSOCIATED WITH SUCH PARTICIPATION INCLUDING,
by way of example, and not limitation: dangers associated with man-made and natural jumps; the dangers of collision with pedestrians, vehicles, other riders, and fixed or moving objects; the dangers arising from surface hazards, including pot holes, equipment failure, inadequate safety equipment, use of equipment or materials provided by the event orga- nizer and others, THE RELEASEES’ OWN NEGLIGENCE, and weather conditions; and the possibility of serious physical and/ or mental trauma or injury, or death associated with the event. For myself, my heirs, executors, administrators, legal repre- sentatives, assignees, and successors in interest (collectively “Successors”) I HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNIFY AND NOT TO SUE the Releasees and all sponsors, organizers and promoting organizations, property owners, law enforce- ment agencies, public entities, special districts and proper- ties that are in any manner connected with this event, and their respective agents, officials, and employees through or by which the event will be held, (the foregoing are also col- lectively deemed to be Releasees), FROM ANY AND ALL RIGHTS AND CLAIMS INCLUDING CLAIMS ARISING FROM THE RELEASEES’ OWN NEGLIGENCE TO THE MAXIMUM EXTENT PERMITTED BY LAW, which I have or which may hereafter accrue to me and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation in or association with the event, or travel to or return from the event. I agree it is my sole responsibility to be familiar with the event course and agenda, the Releasees’ rules, and any special regulations for the event and agree to comply with all such rules and regulations. I under- stand and agree that situations may arise during the event which may be beyond the control of the Releasees, and I must con- tinually ride and otherwise participate so as to neither endanger myself nor others. I accept responsibility for the condition and adequacy of my equipment, any equipment provided for my use, and my conduct in connection with this event. I will wear a hel- met which satisfies the requirements of the Releasees’ Racing Rules or Regulations and that can protect against serious head injury, and assume all responsibility and liability for the selection of such a helmet and any modifications or attachments thereto. I have no physical or medical condition which would endanger myself or others if I participate in this event, or would interfere with my ability to safely participate in this event. I
understand that drug testing may be conducted for athletes registered for this event and that the use of blood boosting or substances prohibited by Releasees’ rules would make me sub- ject to penalties including, but not limited to, disqualification and suspension. I agree to be subject to drug testing if selected, and its penalties if I fail to comply with the testing or am found posi- tive for the use of a banned substance.
I agree, for myself and my Successors, that the above repre- sentations are contractually binding, and are not mere recitals, and that should I or my Successors assert a claim contrary to what I have agreed to in this contract, the claiming party shall be liable for the expenses (including legal fees) incurred by the Releasees in defending the claims. This contract may not be modified orally, and a waiver or modification of any provision shall not be construed as a waiver or modification of any other provision herein or as a consent to any subsequent waiver or modification. I consent to the release by any third party to Releasees and their insurance carriers of my name and medical information that may relate solely to any injury or death I may suffer arising from the event. Every term and provision of this contract is intended to be severable. If any one or more of them is found to be unenforceable or invalid, that shall not affect the other terms and provisions, which shall remain binding and enforceable.
I ATTEST THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER [19 IN ALABAMA] (OR THAT IF I AM YOUNGER , MY PARENTS OR LEGAL GUARDIAN HAVE EXECUTED THIS WAIVER BELOW), AND THAT I AM PHYSICALLY FIT AND SUFFICIENTLY TRAINED TO PARTICIPATE IN ALL ACTIVI- TIES ASSOCIATED WITH THE PROGRAM OR EVENTS AND MY PARTICIPATION IN SUCH PROGRAM OR EVENTS IS VOLUNTARY.

According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) no health information about any competitors can be 
released for information purposes without the express permission of the athlete. HIPAA rules came into full e!ect in April, 2003. We are 
prohibited by federal law from releasing any information without an athlete’s written permission.
• I understand and acknowledge that I am giving permission to provide the information regarding my location, admission to the 
medical tent, medical condition or, if necessary, transfer to a hospital to my spouse, friend or next of kin. I understand and agree 
that to provide this information is voluntary.
• I understand that I have the right to revoke this authorization at any time. I understand that if I revoke this authorization, I must 
do so in writing and present my written revocation to Nathan Triathlon/Red Rock Company, Red Rock Company sta!, agents and/
or volunteers. I understand that this revocation must be submitted to said sta! by 12:01am, September 23, 2012. I understand 
that this revocation will not apply to information that has already been released in response to this authorization. I understand 
that my revocation will not apply to my insurance company when the law provides my insurer with the right to contest a claim 
under my policy. Unless otherwise revoked, this authorization will expire on the following date: 5:00 pm* September 23, 2012.
• I understand that all participants have the right to receive medical treatment by the Red Rock Company medical staff! and volunteers where permitted by law.