FAMILY REGISTRATION PAGE (Must be Completed by Parent or Guardian)

SELECT the TOTAL # of RIDERS from YOUR FAMILY

TELL US YOUR GOAL FOR THE TOUR

Which Category Best Fits Your Family Riding Expectations?

UNSURE BUT MOTIVATED
(Having not ridden a lot, we're excited to see what's possible)
GO 100 COLLECTIVELY AS A FAMILY TEAM
(We'll ride at least 100 miles by adding our miles together)
SOLO CENTURIES - 100 MILES PER INDIVIDUAL
(EACH rider in our family is striving to ride ALL 100 miles)

ADULT AUTHORIZER FOR ALL FAMILY RIDERS

Adult Name

Adult Email

Adult Mobile Phone

Address

ENTER INFO FOR EACH RIDER STARTING WITH YOURSELF (ADD MORE RIDERS NEXT PAGE)

Rider First Name

Rider Last Name

Gender

Male
Female

Participant is a

Kid Rider
Adult Rider

Date of Birth

EVENT WAIVER

Terms & Condtions

As the parent or guardian for the family members entered on this form, I and my family members (my riders) understand that the Century Club Tour (CCT) by CycleHealth, is meant as a "virtual tour" whereby my riders will participate in the CCT as a personal and/or family collective bike riding experience over the designated CCT dates. As such, I assume all risks associated with riding in the CCT for myself and for my riders, including but not limited to: falls, contact with other participants, the effects of the weather, including heat/rain/cold/snow/ice, traffic and conditions that occur on roads or trails, all such risks being known and appreciated.
I know that biking is a potentially hazardous activity, which could cause injury, bodily harm, or even death. By my electronic signature below, I certify that all participants I've registered are able to safely perform the basic skills of bike riding, are in good health, physically fit for outdoor activity, and will be adequately clothed for the conditions. I agree to abide by any decision of a CCT official relative to any aspect of participating in the CCT, including the right of any official to deny or suspend participation for any reason whatsoever. I attest that I have read the description of the CCT and authorize myself or participant/s entered.
Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and for my riders, certify I am entitled to act to waive and release CycleHealth, the YMCA, Three Rivers Park District, all event sponsors, their representatives and successors, from all claims or liabilities of any kind arising out of mine or my riders’ participation in the CCT, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
In addition, I grant permission to all of the foregoing to use photographs of me and my child/ren, motion pictures, recordings or any other record of this event for any legitimate purpose. I further understand that my entry fee is non-refundable.

I have read and agree to the terms above.

Authorizing Adult First and Last Name

TOTAL

Sub Total

$0.00

Running Total

$0.00

Processing Fee

$0.00

NOTE: If the entry fee is a barrier to your kid(s) participating, please email [email protected] to request a scholarship. We never want finances to keep kids from participating.

Coupon Code

Total

$0.00

100 MILES In 10 DAYS (YOU CHOOSE THE DAYS)

FAMILY REGISTRATION PAGE (Must be Completed by Parent or Guardian)

SELECT the TOTAL # of RIDERS from YOUR FAMILY

TELL US YOUR GOAL FOR THE TOUR

ADULT AUTHORIZER FOR ALL FAMILY RIDERS

ENTER INFO FOR EACH RIDER STARTING WITH YOURSELF (ADD MORE RIDERS NEXT PAGE)

EVENT WAIVER

TOTAL

Confirmation