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          Event: Select Distance 25 Miles 50 Miles 80 Miles

                 Free Massage After Bike Ride

T Shirt Size: Select One Small Medium Large X Large XX Large

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

I, the undersigned PARTICIPANT, for myself, my heirs, successors, assigns, and personal representatives, HEREBY: 1. UNDERSTAND AND ACKNOWLEDGE that The Great Escape is a recreational event, and ASSUME any and all risks that might be associated with The Great Escape; 2. WAIVE any and all claims, causes of action, and bases of liability against, and release, discharge, hold harmless, and covenant not to sue the State of Kansas; any agency or subdivision thereof; El Dorado Correctional Facility; Central Kansas Prison Ministries; along with any other sponsor and all of its holdings; owners and lessees of premises used to conduct the event; the dealers, officers, directors, management, officials and volunteers assisting in the event; the sanctioning organization or any subdivision thereof; grounds operators; grounds owners; officials; promoters; sponsors; advertisers; and EACH OF THEM, their employees, agents, officers, members, sponsors, organizers or other representatives, successors, heirs, or assigns; each and all herein referred to as “RELEASEES,” for any injuries or damages of any kind whatsoever, regardless of the cause(s) of said injuries or damages, whether caused by the negligence of the RELEASEES or otherwise, arising out of or suffered as a result of taking part in The Great Escape and/or related activities; 3. AGREE to indemnify and save and hold harmless the RELEASEES and each of them from any loss, liability, damage, or cost (including attorney’s fees) they may incur due to PARTICIPANT’S attendance at or participation in The Great Escape and/or related activities, whether caused by the negligence of the RELEASEES or otherwise; 4. AGREE not to use or operate any vehicle in violation or contravention of any City, County, State or Federal law, statute, ordinance, or regulation, and to be personally liable for all fines and penalties for any such violations; 5. ACKNOWLEDGE AND AGREE that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by law of the State of Kansas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect; AND 6. UNDERSTAND AND ACCEPT that in the course of my attendance at and participation in The Great Escape, film or photographs may be taken, or illustration or recording may be made, of me and/or my personal property (including my bicycle). I acknowledge and agree that such film/photographs and/or illustrations/recordings may be used in any medium by the RELEASEES for advertising and promotional purposes without compensation or further notice to me. The undersigned has read and voluntarily signs this Release and Waiver of Liability and Indemnity agreement, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

Agree With Waiver: Select One Yes

Select yes if you understand and agree with the above waiver.  You must agree with the waiver in order to participate in this event.

Signature (Required For All Participants):      

Signature above must be signed by parent or guardian if under 18

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