Step 1 of 4 (Registration Agreement)

Quad Cities Bicycle Club - Annual Membership

in Quad Cities, IA at the borders of the scenic Mississippi River in Illinois and Iowa

  • Couple

* Click here for fee information

Waiver, Consent and Release of Liability

I acknowledge that membership in the QCBC or participation in any QCBC Event (hereafter referred to as the Event) is a test of a person's physical and mental limits and carries with it the potentialfor death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of roads, highways and trails, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration.

These risks are not only inherent to the riders, but are also present for volunteers. I hereby assume all of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective highways, equipment or property owned, maintained or controlled by them or because of their possible liability without fault.

I agree to obey all traffic laws of the hosting state and to wear an approved helmet while cycling in this event. I certify that I am physically fit, have sufficiently trained for participation in the Event and have not been advised otherwise by a qualified medical person.

I acknowledge that this Accident Waiver and Release of Liability form will be used by the Event holders, sponsors and organizers, in which I may participate and that it will govern my actions and responsibilities at said events.

In consideration of my application and permitting me to participate in this Event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns as follows: A) Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Quad Cities Bicycle Club, its directors, officers, employees, volunteers, representatives, ride leaders, and agents, the Event holders, Event sponsors, Event volunteers and all state, county, and municipal agencies responsible for maintenance of the highways, trails upon the Event itinerary (hereafter referred to as Releasees); and (B) Indemnify and Hold Harmless the entities and persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this Event, whether caused by the negligence of Releasees or otherwise.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during this Event.

I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors organizations and assigns.

The Accident Waiver and Release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I have read this release, understand its content, and agree to its terms.

Parent or legal guardian must sign for, accompany, and be responsible for all persons under the age of 18:

I authorize emergency medical treatment for the minor registering and I accept full responsibility for all medical expenses incurred as a result of the minor's participation/volunteering in any event. I hereby RELEASE from any liability, and agree to HOLD HARMLESS and INDEMNIFY Quad Cities Bicycle Club plus each and all entities or persons referred to above by me, another parent, grandparent, relative or legal guardian for liability, including injury, loss or damage caused by the negligence, unintentional acts of omission of any party, and any loss or expense, which may arise from the minor's participation in any event. I hereby further agree to INDEMNIFY Quad Cities Bicycle Club plus each and all entities or persons referred to above from any future claim of liability by the minor named below.

I further state that I am of lawful age, a parent or legal guardian of the minor authorized to sign this waiver & release, and this Addendum and legally competent to waiver and release Addendum. I understand that the terms of this document are contractual and not merely recital, and have signed this document of my own free act. I have read this release, understand its content, and agree to its terms.

Please Sign Below

Your electronic signature is the online equivalent of your ink-on-paper signature, and can be provided by typing your name where indicated. The electronic signature will signify your understanding, acceptance, and authorization to accept the conditions of this legal document, including the following statements:

  • I have read, have understood, and do accept the agreement above.
  • I understand that this is a legal document with effects that I approve and authorize.
  • The registrant is the person(s) whose name is submitted as the recipient of the goods and services provided as a result of this transaction.
  • I am authorized to agree to the terms of this document on behalf of the registrant.
  • If the registrant is under 18 years of age, incapacitated, or mentally challenged, I assert that I am the parent/legal guardian or otherwise authorized to execute a legally binding agreement on behalf of the registrant.

Electronic Signature

You must be 18 years of age to legally complete this registration. If the registrant is under 18, an authorized adult must complete this form.
If the person you are registering (registrant) is under 18, do not enter his/her age. You will do that on the next step. Enter your age here as the person completing the form.

Multiple signers should separate their signatures with commas.

This agreement was generated at 8:50:29 AM EDT on 05/23/2019.

Click here to print the agreement.

You are encouraged to keep a copy of this agreement for your records. This agreement was generated at 8:50:29 AM EDT on 05/23/2019

  • American Express Discover Card Mastercard Visa
  • When this page loaded, the official time was 8:50:29 AM EDT.