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Bikes For Bluejays Registration Form
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Price Schedule
Through
07/28/2024
Through
08/28/2024
Final
Registration
$55
$65
$75
Categories
Registration -
$75.00
Participant Information
Contact Email
*
Participant First Name
*
Participant Last Name
*
Participant Birthdate
*
- month -
Jan
Feb
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- year -
2024
2023
2022
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1921
1920
1919
Participant Gender
*
Male
Female
Country
*
-- select country --
Canada
International
United States
Street Address (w/Apt#)
*
City
*
State
*
-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-- select province --
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Zip Code
*
Phone
*
Would you like to
receive important event text alerts
on this number (eg. changes or delays)?
Emergency Contact Name
*
Emergency Phone
*
Select the size of your free event shirt
*
-- select one --
XS
S
M
L
XL
Which Distance Will You Ride? (You can always change, this helps us plan rest stops)
*
100k/~60mi
50k/~30mi
22k or 32km/~14mi or ~20mi
Make a Donation
Make a Donation to Bikes For Bluejays Ride
Amount $
Please consider a donation to help purchase bikes & helmets for the students at Littleton Academy Bluejays
Waiver
*
Read this document completely before signing. This document has legal consequences and will affect your legal rights and will limit or eliminate your ability to bring future legal actions. In consideration of being allowed to participate in any way in Lake Gaston Outfitter LLC events and activities, the undersigned acknowledges, appreciates and agrees that: 1. I HEREBY ACKNOWLEDGE AND ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am physically fit, have sufficiently trained and prepared for this event, and have not been advised otherwise by a qualified medical person or other healthcare provider. I have no physical or medical condition that would endanger myself or others if I participate in the event or would interfere with my ability to safely participate in the event. I acknowledge that this athletic event carries with it the potential for death, serious injury, and property loss. The risks include but are not limited to, to collision with pedestrians, vehicles, other participants, animals, and fixed or moving objects; those caused by surface hazards, including potholes; equipment failure; inadequate safety equipment; use of equipment or materials provided to me by others; facilities, temperature, weather, condition of athletes, lack of hydration, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, journalists, Event officials, Event monitors, and/or producers of the event. The risks are not only inherent to participants but are also present for volunteers and support staff. I hereby assume all of the risks of participating and/or volunteering in this Event; and, 2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and, 3. I have read, understand, and agree to abide by the rules of the event as published on the event website https://event.racereach.com/bikes-for-bluejays. I know that music players such as MP3 or similar devices are not allowed at this event. I certify that my bike is properly maintained and equipped for the event and that I will only use a bike that is within the event rules. I understand that Lake Gaston Outfitter LLC reserves the right, in its sole and complete discretion, to deny entry, revoke the entry application of any applicant at any time, and/or to disqualify any individual from the event. Applicant expressly waives any claim for damages arising from the denial or revocation of an entry application exceeding the amount of the entry fee. 4. The risk to have contact with individuals, who have been exposed to and/or have been diagnosed with one or more communicable diseases, including but not limited to COVID-19 or other medical conditions, diseases, or maladies does exist, and it is impossible to eliminate the risk that I could be exposed to and/or become infected through contact with or close proximity with an individual with a communicable disease; and, 5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby indemnify and hold harmless Lake Gaston Outfitter LLC, Lakeland Cultural Arts Center and Littleton Academy, their officers, officials, agents and/or employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers and if applicable, owners and lessors of premises used to conduct the event, all state agencies including the North Carolina Department of Transportation, city, town, county, and other governmental bodies, and/or municipal agencies whose property and/or personnel are used and/or in any way assist in locations in which the event or segments of the event take place, and each of their respective parent, subsidiary and affiliated companies, licensees, officers, directors, partners, board members, shareholders, members, supervisors, insurers, agents, employees, volunteers, and other participants and representatives (Released Parties); and, 6. I grant to Lake Gaston Outfitter LLC, Lakeland Cultural Arts Center and Littleton Academy my permission to use without charge, at this event or related activities, the rights to be photographed, filmed and/or videotaped. I agree to allow my name, photo, video, or film likeness to be used for any legitimate purpose by event holders, producers, sponsors, organizers, and assigns.; and, 7. I understand that Lake Gaston Outfitter LLC, Lakeland Cultural Arts Center and Littleton Academy staff are not responsible for loss, theft, or any damages to personal property which include, but not limited to bicycles, vehicles, etc.; and, 8. In order to protect the health and safety of all participants, I understand and agree that Lake Gaston Outfitter LLC may determine that the event may be cancelled, postponed or terminated at any time with no refund and I may not be able to participate or complete the event. There will be no refunds for bad weather situations, force majeure events, acts of God, etc.; and, 9. I have read and agree to the Lake Gaston Outfitter LLC Cancellation and Refund Policy; and, 10. I agree that I will not issue a credit card chargeback or funds reversal at any time.;
Read through the agreement.
I have read and agreed to the TERMS
*
Is the participant 18 or older?
*
18 or older
Under 18
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian.
If registering a child under 18, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
Parent's signature
Payment Details
Discount or Tracking Code
Apply
Do not COPY & PASTE the code, please type it into this field.
Price
$
Discount (-)
$
Total
no handling
$
Handling
$
Donation
$
Total Owed
$
Payment Method
The payment and credit card section is not visible because there is nothing owed or form fields have not been fully completed.
Visa
Mastercard
Amex Card
Payable To:
Address:
click the "submit" button to submit your order then send a check to (or pay in person at) the address above.
1. Venmo the total amount to the Phone #:
2. Make sure you enter the code,
58764
in "What's it for".
3. Click the "pay now" button.
Enter a Check Number
Enter a Check Amount
Send email receipt to the participant
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