St. John's Cycling Club Membership Form

Name: ___________________________
Tel (H): __________________________
Tel (W): __________________________
Address: __________________________________________________________

Fee Schedule

Waiver

Please read the following carefully and sign at the bottom.

In applying for membership of the St. John's Cycling Club, I recognize that such related sporting, training and recreational activities as may from time to time be conducted by the St. John's Cycling Club, are potentially hazardous. I hereby assume all risks associated with taking part in the activities of the St. John's Cycling Club. The hazards include, but are not limited to, the possibility of falls, contact with other participants, encounters with other road users, the effects of severe weather conditions and road conditions. It is possible that accidents arising from these or other road hazards may lead to serious injury and possibly death.

I should not take part in such activities if I am not medically fit, nor if my level of competence is such that I would be a greater hazard than properly skilled participants. I agree to abide by the decision of any official of the St. John's Cycling Club or Race Commissaire regarding my competence for a particular activity.

Having read this statement, and knowing these facts, I for myself and for anyone entitled to act on my behalf, release the St. John's Cycling Club and its' officers, employees or agents and any and all sponsors and the representatives and successors of the aforementioned, for all liabilities of any kind arising from my participation in any activity of the St. John's Cycling Club and I hereby waive my right to any claim against them.

Signature of Applicant: ______________________
Signature of Applicant or Guardian for Applicant under 19: ______________________
Date: __________________

Please fill in the following:
In case of emergency please contact:

Name: ___________________________
Relationship: ___________________
Address: ___________________________
Telephone (H): ___________________________
Telophone (W): ___________________________

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