Summer Moon Festival
Bike Tour
Wapakoneta Family YMCA
Saturday, July 22, 2017
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12-miles Family Friendly!
25-miles
40-miles
Visit www.wapakymca.org for a
62-miles
detailed Bike Tour brochure.
12 miles: 5 points
25 miles: 10 points
40 miles: 15 points
62 miles: 25 points
Join us for the 15th annual Summer Moon
Festival Bike Tour! You’ll love this midsummer ride through the
beautiful Auglaize County countryside!
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Routes to accommodate all ages and abilities!
4 snack stops available: refreshments, fresh fruit, Dannon yogurt and our
popular homemade cookies!
Arby’s Roast Beef Lunch is provided for cyclists from 10:30 am-2 pm while
supplies last.
Each cyclist will receive a $3 voucher good toward food and drink at the
Summer Moon Festival.
Stay for the rides and entertainment at the Festival!
Ride begins from 7:00 am-8:00 am at the Wapakoneta Family YMCA, 1100
Defiance St., Wapakoneta, OH 45895.
Helmets are MANDATORY to participate in this ride!
Bike Trailers are welcome!
Bike Tour Registration-2016
Name_________________________________________Phone_________________________E-mail _______________________________________
Address______________________________________________ City____________________________________State________Zip____________
Birthdate__________________Emergency
Name_______________________________Emergency Phone__________________________
Please circle one:
Early registration with shirt $25 (Postmarked by June 23)
Ride Without a Shirt
$15 (Postmarked by July 14 or bring day of ride)
Late registration with shirt $30 (Postmarked by July 7 will guarantee shirt)
Make checks payable to:
Wapak Family YMCA
Attention: Kelly
1100 Defiance
Wapakoneta, OH 45895
* a limited number of shirts will be available for purchase the day of the ride
Road to Fitness Participant: Yes____ No____
Distance:
12
25
40
62
Shirt size: S M L XL XXL (add$2) XXXL (add$2)
T-shirts available for children in bike trailers for $10/shirt. Specify size and quantity below.
YXS_____ YS_____
YM_____
YL_____
YXL_____
(2-4)
(6-8)
(10-12)
(14-16)
(18-20)
Consent to Participate & Release of YMCA from Liability
I agree to the following:
a. I will follow the rules and policies of the Wapakoneta Family YMCA. I agree that the rules and policies should be followed by my son, daughter, or other
child and I will support the YMCA in that regard.
b. I understand the risks associated with the activity I or my son, daughter, or other child will engage in at the YMCA, and being so informed, I knowingly
accept these risks and consent to participation in the activity. I will supervise my child’s participation, if I believe it is prudent. I release the Wapakoneta
Family YMCA and agree to hold it harmless from any and all liability, damage or loss of any kind whatsoever caused by my participation or the participation of
my son, daughter or other child in the above referenced activity.
I have agreed to the above statements, release, and indemnification provision on my own behalf, my child’s behalf, and on behalf of my heirs, executors,
personal representatives, and assigns and I intend to be legally bound hereby.
I grant permission to the Wapakoneta Family YMCA to publish, distribute, or otherwise use photographs taken of me, my child, or other participants during any
and all YMCA activities for YMCA promotional purposes.
Date:______________________ Signature: _________________________________________________________________(Parent of Participant under 18 years of age)
Signature: ________________________________________________________________(Adult Participant)