Registration Form

P.E.D.A.L (Publically Exhibiting Diversity Across all Lanes) is proud to hold its first annual bike ride on June 10, 2017! By filling out the form below, you are agreeing to the terms and conditions set forth by Front Yard Bikes in partnership with BREC Extreme Park.

June 10, 2017 | 8am - Noon | Glasgow Middle to BREC BMX Park

Please write N/A if not applicable.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian Name (if minor)

First Name

Last Name

Relationship to Participant

Contact Name/Phone Number

Adult Participants Phone Number

(###)

###

####

Do you need a loaner bike?

Yes

If yes,

Please indicate what kind of bike you would like to use. Please understand that bikes loaned are on a first come basis. Please include whether you will need an adult or childrens bike and your height.

Terms & Conditions

I understand that riding bikes may be dangerous and I will not hold Front Yard Bikes or any of their partners liable for any injury that might occur to myself or the minor I am representing. In the case of an emergency, Front Yard Bikes or confirmed partners will make reasonable effort to contact the guardian or emergency contact listed above and, if deemed appropriate by Front Yard Bikes, administer first aid and/or seek medical care for adult participants as well as minors. Any expense related to said aid & care is the participants’ responsibility. Any costs incurred by Front Yard Bikes or appropriate partners, will be reimbursed by the participant. By checking this box, you agree to the conditions set forth by Front Yard Bikes and its partner organizations, agree to release Front Yard Bikes from all liability that might arise from participating in P.E.D.A.L events.

I understand