Revo Devo Registration Form Rider Registration Form "*" indicates required fields Child #1 Name* First Last Child #1 DOB?* Month Day Year Child #2 Name First Last Child #2 DOB? Month Day Year Child #3 Name First Last Child #3 DOB? Month Day Year Child #4 Name First Last Child #4 DOB? Month Day Year Parent or Legal Guardian Name (Primary)* First Last Relationship to Child* Phone Number (Primary)*Email Address (Primary)* Parent or Legal Guardian Name (Alternate) First Last Relationship to Child Phone Number (Alternate)Email Address (Alternate) Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How many years has your child been riding/racing bikes? Participation Waiver* I agree to the Participation Waiver.I, the parent and/or legal guardian named above of the child named above, a minor, understand the nature of bicycling activities and the minor’s experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity. I hereby release, discharge, covenant not to sue and agree to indemnify, defend, and hold Revolution Development Cycling, Inc., its officers, agents, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity takes place (collectively, the “Indemnified Parties”) harmless from all liability, claims demands, losses or damages associated with the minor’s participation in any bicycling or other activities with the Indemnified Parties, whether caused or alleged to be caused, in whole or in part, by the negligence of the Indemnified Parties or otherwise, including, but not limited to, negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the Indemnified Parties named above, I will indemnify, defend and hold each of the Indemnified Parties harmless from any litigation expenses, attorney fees, loss, liability, damage or cost any may incur as a result of any such claim.Team Agreement* I agree to the Team Agreement.In consideration of Revolution Development Cycling Junior Cycling Team, family membership, heretofore known as Revolution Development Cycling, I, the participating child ("Child") and his/her parent ("Parent" and together with the Child and other members of their family, the "Family") hereby agree and acknowledge as follows: 1. The Child agrees to always wear a helmet whenever the Child rides his/her bicycle. 2. The Child shall not take inappropriate risks (willingly attempt anything which is beyond one’s ability to control their bike safely). The Child will listen to and abide by the directions of the coach when at a practice and/or race. When on trails the Child shall ride responsibly and limit damage and erosion to trails and the environment. When on the road the Child will follow all traffic laws. Your behavior reflects upon the team as well as sponsors and Revo Devo Cycling itself. Think of yourselves as ambassadors for the team, the sport of cycling, and your community. 3. The Family will conduct themselves in a positive and mature manner at all times, including showing respect for others while wearing or using the Revolution Development Cycling logo or products; failure to do so can lead to the Child's release from the team as determined by the board. 4. The Child and Parent, on behalf of themselves, the Family, and their respective successors and heirs, hereby release, indemnify and hold Revolution Development Cycling harmless and all of its sponsors from any and all claims and causes of action, losses, liabilities or costs, of whatever nature involving, but not limited to, physical or mental injury to the Child, Parent, any member of their Family, or any third party, relating to or in any manner connected with my membership in the Family's involvement with Revolution Development Cycling or my Family's use of any products, clothing materials or equipment provided to me by Revolution Development Cycling or any of the Revolution Development Cycling sponsors. 5. The Family shall follow the IMBA, USA Cycling, USCF, NORBA and NCNCA rules and regulations and codes of conduct. 6. The term of this agreement shall be for the calendar year of submission and is not assignable or transferable; Dues expire and must be repaid 4/1 of each year. 7. The Family understands and agrees that the members of Revolution Development Cycling shall be held to a strict code of ethics and standards. Revolution Development Cycling may cancel the Family's membership in the event of poor Revolution Development Cycling representation or poor conduct or violation of any of the above provisions. Revolution Development Cycling shall have the right to censure, suspend, and or revoke rider membership should any member of the Family behave inappropriately or unprofessionally during an event. Event shall be defined as a Revolution Development Cycling sponsored race, special event, or training ride, USA Cycling sanctioned race or Non USA Cycling race. 8. By accepting this agreement the Child and Parent acknowledge that each has reviewed this agreement and will abide by the policies set forth in this agreement and if he or she fails to comply, I understand the Revo Devo Cycling Board may decide to remove my child from the team. I agree that I will attend practices, and racing events and support my child and the Revo Devo Cycling team. At practices, races and other events where my child is participating and representing Revo Devo Cycling, I will behave in a manner respectful of all. Behavior at all times will show good sportsmanship to all teammates, parents, coaches, sponsors and other participants and parents. If at a practice or a race I observe behavior inconsistent with this Code of Conduct, I will report it to the coaches, and not address the individual directly. If my behavior is found by the Revo Devo Cycling Board they, in their discretion, can take disciplinary actions against me which may include refusing my attendance at practices or races, or removal of my child from the Revo Devo Cycling team. In the event Revolution Development Cycling terminates the Family membership, the Child shall immediately return any Revolution Development Cycling products and equipment provided but not paid for by the Family.Medical Consent* I agree to the Medical ConsentI, as the parent and/or legal guardian of the child(ren) named above, a minor, give my consent to Revolution Development Cycling and its representative/coaches to obtain medical care from any licensed physician, hospital, or clinic for the above mentioned athlete, for any injury that could arise from participation in Revolution Development Cycling sanctioned events, including practices and races.Media Waiver* I agree to the Media WaiverI authorize you to use the following information relating to me, my children and my family: My picture – including photographic, motion picture, and electronic (video) images. I hereby grant to you the right to use, publish, and reproduce, for all purposes pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences and in brochures and other print media. I further grant you all right, title, ownership and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant you the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, advertising or for any other purpose, as it deems fit. I also understand that Revolution Development Cycling is not responsible or liable in any way for photos that other members post on social media or otherwise share or distribute as we have no control over others’ actions. Should I object to a photo of me or my child being posted or shared by another member, I understand that I need to contact that member directly and ask him/her to remove or take down the image as Revolution Development Cycling is not involved or responsible for that situation.Electronic Signature Agreement* I AcceptBy selecting the "I Accept" checkbox, I am signing this agreement electronically. I agree this electronic signature is the legal equivalent of my manual signature on this agreement. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.NameThis field is for validation purposes and should be left unchanged.