Everyone who participates in a C4 sanctioned club ride must fill out a waiver. YOU DO NOT need to be a paid club member, but the waiver must be completed once every year. The waiver will be valid until the end of this year 2025, at which time a new waiver will need to be submitted. The purpose of the waiver is to validate your willing participation, and allow you to be eligible for insurance benefits carried by the club for incidents where there is a liability concern. This information is private and is not shared with any entity until which time it is needed to make a claim.First Name Last Name Age Under 18?Email Address Phone Number Emergency Contact Emergency Phone Number Emergency Medical Information Optional entry to notify us of any medical condition or allergy you may have in case of an emergency. C4 Release of Liability In consideration of being allowed to participate in any way in the Central Carolina Cycling Club program, its related events and activities, I acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Central Carolina Cycling Club immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Central Carolina Cycling Club, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.Accept TermsBy checking this box I certify that I have read and agree to these terms I accept.Participants Signature - Please sign below Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian Signature Send
