2017 Cow Creek Country Classic
ENTRY FORM

Please print this form and mail to:
Cow Creek Country Classic
P.O. Box 2920
Attn: Melissa Ballard
Waxahachie, Texas 75168

(PLEASE PRINT)

Name: ___________________________________________________________________
 
Address: ___________________________________________________________________
 
City: _______________ State:  ________ Zip:  _______ Phone:  __________
 
Email: ___________________________________________________________________
 
Date of Birth: ______________________________
 
Did you ride last year (please circle)? YES    NO
 
Where did you obtain this form? _______________________________________

I plan to ride (please circle): 10 20 41 60 80 102 miles
 
T-Shirt Size (please circle): M L XL XXL  

*ALL RIDERS $35.00 AFTER June 12
Individual Rider @ $35.00*: $____________
Tandem Rider @ $35.00 each (2 riders on a tandem bike)*: $____________
Family Rider @ $35.00 each (4 or more same address)*: $____________
Corporate Rider @ $35.00 each (8 or more riders same organization)*: $____________
Name of Organization _____________________________
 


Total Enclosed: $________________________


TO PAY BY CREDIT CARD

Enter your credit card information:


Type of Credit Card (please circle): Visa MasterCard
 
Name on Card:  ____________________________________________________________
 
Billing Address:  ____________________________________________________________
 
   ____________________________________________________________
 
Card Number:  ____________________________________________________________
 
Expiration Date:  _______________________________ Security Code:  ___________
 
Signature:  ____________________________________________________________


TO PAY BY CHECK

Make check payable to ROTARY CLUB OF WAXAHACHIE and enclose with form.





For additional information or a list of accommodations, please visit our website at
www.cowcreekcountryclassic.org
or call the WAXAHACHIE CHAMBER OF COMMERCE at
(972) 937-2390 9 AM to 5 PM, Monday through Friday

No Refunds – No Confirmation or Packets Mailed.
For additional entries photocopies may be made.




RELEASE FORM

YOU MUST SIGN RELEASE IN ORDER TO RIDE

NOTICE: THIS ENTRY BLANK AND RELEASE FORM IS A CONTRACT
WITH LEGAL CONSEQUENCES. READ IT CAREFULLY BEFORE SIGNING.

In consideration of the acceptance of my application for entry in the Cow Creek Country Classic, I hereby freely agree to make the following contractual representations and agreements.
I fully realize the danger of participating in a bicycle ride and will assume the risks associated with such participation including, by way of example, and not limitations, the following: danger of collision with pedestrians, vehicles, other riders and fixed or moving objects; the dangers arising from surface hazards, and weather conditions; the danger of cycling on highly traveled roads and highways where vehicles travel at a high rate of speed; the failure to keep proper lookout, and the possibility of serious physical and/or mental trauma or injury associated with athletic cycling events.
I hereby waive, release, and discharge for myself, my heirs, executors, administrators, legal representatives, assigns, and successors in interest (hereinafter collectively “successors”) any and all rights and claims which I have or which may hereafter accrue to me against the sponsor(s) of this event, the Waxahachie Rotary Club, its members, officers and agents, the promoter and any promoting organization(s), proper owners, law enforcement agencies and all public entities through or by which the events will be held for 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 and return from the events.
I agree it is my sole responsibility to be familiar with the course, the rules, and any special regulations for the event. I understand and agree that situations may arise during the ride which may be beyond the immediate control of the ride officials or organizers, and I must continually ride so as to neither damage myself or others. I accept responsibility for the condition and adequacy of my equipment. I have no physical or medical condition which to my knowledge would endanger myself or others or would interfere with my ability to participate in this event. I further agree that if I choose to participate in this ride and not wear an approved helmet I can be subject to serious
head injury and assume all liability and responsibility for injuries arising from failure to do so.
I agree, myself, my heirs, administrators, legal representatives and successors and assigns, that the above representatives are contractually binding and are not mere recitals, and that should I or my successors assert my claim in contravention of this agreement, I or my successors shall be liable for all expenses (including legal fees) incurred by the other party or parties in defending, unless the party or parties are fully adjudged liable on such claim for willful or wanton negligence. This agreement may not be modified orally, and a waiver of any provisions shall not be construed as a modification of any provision herein or as a consent to any subsequent waiver or modification.
I also grant full permission to any and all sponsors to use photographs, photography and records of this event for any purpose.
PARENT OR GUARDIAN OF A MINOR: I as a parent or guardian of the below named minor, hereby give my permission for my child or ward to participate in the event, and further agree, individually and on behalf of my child or ward, to the terms of the above.

______________________________________________________ _________________
RIDER’S SIGNATURE DATE
 
______________________________________________________ _________________
PARENT/GUARDIAN SIGNATURE IF RIDER IS UNDER AGE 18 DATE