Form test – Solstice Century

Registration Form Test

Name *

Phone *

Email *

Address, City, State, Zip *

Emergency Contact & Phone Number *

Commitment *I commit to raise $1,000 for one of the 3 options below

Charities *Mental Health Services: SamaraCare, Grow Wellness Foundation, and Max’s MissionCommunity Services: Hesed House, DuPage Pads, and Loaves & FishesI’d like to talk to Zac about a unique charity for consideration.

Please provide Charity Name and EIN Number for approval(If you do not know the EIN now, we will reach out for it.)

Do You Need to Rent a Bike and Helmet the Day of the Ride *YesNo

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THE Solstice Century Ride 2024, including by way of example and not limitation, any risks that may arise from the negligence or carelessness on the part of the persons or entities participating in the Solstice Century Ride 2024, whether the result of dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit and I certify that there are no health-related reasons or problems which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the Solstice Century Ride 2024 in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: All managers, members, officers, employees, volunteers, representatives, agents, successors and assigns of INTENTGEN FINANCIAL PARTNERS, LNS OPERATIONS, LLC along with their volunteers, representatives, and sponsors; (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that INTENTGEN FINANCIAL PARTNERS, LNS OPERATIONS, LLC, their managers, members, officers, employees, volunteers, representatives, agents, successors and assigns are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I acknowledge that this activity may involve a test of a person’s physical and mental limits. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS WAIVER AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.