Arlington Kids Ride

Please print these pages and mail them to me

Ethan’s Mule Ride Awareness and Milestones Arlington Loop Sunday, July 8, 2007
First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

Email:

Age:

Gender:

Emergency Contact Information:

Name:

Phone:

Relationship:

To:
Ethan Grant

P.O Box 50161

Attn: Ethan’s Mule Ride Arlington Loop

Arlington, VA 22205-9998

Registration form and payment must be received by Monday, July 2, 2007.
You can also use pay pal email ME and me or Isabelle will respond with the information you need. Thanks .

Want to give More

If you cannot attend but would like to contribute, please consider a tax-deductible donation to Curesearch or any of the great organizantions on my home page

If you would like to make a donation in addition to your registration fee, please enter the information here.

Donation Amount: $

If you would like us to send a gift acknowledgement to an honoree, enter their name and address below.
Name:

Address:

City,

State

Zip:

Legal Stuff Please read it and sign it .

RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY In consideration of being permitted to participate in any way in the Ethan’s Mule Ride and activities, I for myself, my personal representatives, assigns, heirs, and next of kin: 1: Acknowledge, agree and represent that I understand the nature of this event and that I am qualified in good health, and in proper physical condition to participate in such event. I further acknowledge that the event will be conducted over public roads and facilities open to the public during the event and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the event. I further understand that serious accidents occasionally occur during bicycle riding and the participants in bicycle riding occasionally sustain mortal or serious physical injury and/or property damage, as a consequence thereof. Knowing the risk of bicycle riding, nevertheless, I hereby agree to assume these risks and to release and to hold harmless Ethan’s Mule Ride, its officers, employees, agents, partnering agencies, event sponsors, and all persons or entities associated with Ethan’s Mule Ride who (through alleged negligence or carelessness), might otherwise be liable to me (or my heirs or assigns) for damages. It is further understood and agreed that this waiver, release, and assumption of risk, is to be binding on my heirs and assigns. 2: Further, I hereby agree to abide by the rules and regulations governing this event and elect to participate at my own risk and in consideration for being allowed to participate do hereby release and discharge Ethan’s Mule Ride , its officers, employees, agents, partnering agencies, event sponsors, and all persons or organizations connected with the event from any and all liability (including death) that may be received by me and from all claims and demands to my personal property growing out of or resulting from my participation in the event. 3: Acknowledge that all riders must at all times wear a buckled ANSI/SNELL approved helmet during participation in the event. 4: Acknowledge that all participants age 16 and under must ride with an adult. 5: I also understand that the entry fee paid by me is non-refundable. I HAVE CAREFULLY READ AND UNDERSTAND THIS WAIVER All riders being registered must sign this release. Signature of parent or guardian is required if applicant/rider is under 18 years of age. _______________________________________ Date__________ Participant Signature _______________________________________Date:__________ Guardian Signature for Riders Under 18

Arlington Loop