MECCA Bicycle Club
             
Spring Festival
April 26 -28, 2024
Buckhorn RV Park
Huntington, Utah
Children 12 and under ride and eat for free, but won't be eligible for prizes, t-shirts or swag bags
 
Amount:   $90.00   Select:   Item Subtotal:  
$0.00
T-Shirt Size
             Registration includes meals and goodie bags.
Registration after April 15th 2024 will increase to $90.00, with no guarantee of a t-shirt or "goody" bag.
Meal Only:   $25.00   Quantity:   Item Subtotal:  
$0.00
               Guest Meals, includes only meals - no guided rides, tee shirt, prize, etc - for guest(s) of participants.
Meal tickets purchased after April 15th  will be $25.
 
Additional t-shirts:   $10.00   Quantity:   Item Subtotal:  
$0.00
Shirt Size [1]

Shirt Size
[2]

Shirt Size
[3]

Shirt Size
[4]

Shirt Size
[5]

Shirt Size
[6]

Shirt Size
[7]

Shirt Size
[8]

Shirt Size
[9]

Shirt Size
[10]
 
Total:
$0.00
Promotion Code    (Discount applied before final submission)
 
Weather permitting all activities will be done outside.
Please bring your own lawn chair
 
Registrant's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:

I acknowledge that this athletic event is an extreme test of a person's physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, water conditions including pollution, temperature, currents and waves, weather, condition of athlete's equipment, vehicular traffic, actions of other people including, but not limited to participant, volunteers, spectators, coaches, event officials and event monitors, and/or procedures of the event, and lack of hydration. I hereby assume all of the  risks of participating in this event. I certify that I am physically fit, have sufficiently trained for participation in this event, and have not been advised otherwise by a qualified medical person.

I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by Emery County Recreation Department and the event of holders, sponsors, and organizers, in which I may participate and that it will govern my actions and responsibilities at said events. In consideration of my application and permitting me to participate in the event, I hereby take actions for myself, my executors, administrators, and heirs, next of kin, successors, and assign as allows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from event, THE FOLLOWING ENTITIES OR PERSONS: Emery County Recreation Department and its directors, officers, employees, volunteers, representative and agents, the event holders, event sponsors, event directors, event volunteers, (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of any of my actions during this event.

I hereby consent to receive medial treatment which may be deemed advisable in the event of injury, accident and/or illness during this event. I understand that at this event or related actives, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and/or assigns.

This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

IF UNDER 18-PARENT/GUARDIAN WAIVER FOR MINORS

The undersigned parent and natural guardian or legal guardian does thereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damage whatsoever may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of both the minor and the parents of legal guardian.

AUTHORIZED FOR MEDICAL TREATMENT
This release will authorize Emery and Green River Medical Center, Castleview Hospital, and the Emery County Ambulance Service to provide medical treatment in the event of an accident or illness while participating in the recreation programs of the Emery County Recreation Department. I understand that these services are provided on fee basis.

Participant
I have read, understand, and agree to the AWRL Waiver.
*If participant is under the age of 18
Please list name of parent/guardian completing this form.
 
Payment Information:
Processing Fee Rates:
Cards:2.9% plus $0.30
eCheck:$0.49
Method of Payment:
  Credit/Debit Card
  eCheck
 Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
For assistance, call 435-749-0755
 
MECCA Bicycle Club
P.O. BOX 491 - Huntington, UT 84528-0491
meccabike01@gmail.com
Website - biketheswell.org
 
 
Submitting ...
CORE Payments © 2024 CORE Business Technologies. All rights reserved.
~ Our Solutions ~ Privacy Policy ~ Contact Us ~
CORE Payments Version 4.1.17016; (API: 2.22)
RSI Security