Scottsbluff Nebraska Community Family Fun Ride
The “Y” Not Ride
Registration Time: 7:00am
Saturday, May 6, 2017 Start Time: 8:00am
Rules of the road
First Name:
1. All riders must sign the release form before starting
the ride.
2. All riders under 16 years of age must have the form
signed by a parent or guardian, and carry a medical
release authorizing any needed treatment.
3. ANSI/Snell-approved helmets must be worn at all
times during the ride.
4. Bicyclists must obey all Nebraska vehicle code laws
including all stop signs and signals. Violators may be
cited by local authorities.
5. Whenever possible, ride single-file.
6. Riders must make certain that their bicycles are in
good operating condition prior to the ride.
7. Riders on 28 & 54 mile rides should carry a spare
tube or patch kit, pump, tools, water bottle, chap stick,
sunblock, telephone, money and identification.
8. Fully supported ride with sag vehicle.
Last Name:
Street Address:
City, State, Zip Code:
Phone Number:
Email Address:
Emergency Contact Name:
Liability Waiver
Emergency Contact Phone Number:
Gender:
Female
Under 16:
Male
Event(Mark 1):
3 Mile Family Ride* $5 (Maximum $15 per family)
9 Mile Family Ride * $5 (Maximum $15 per family)
Note: All children must be accompanied by parent/guardian
at all times on family rides. Requires Parent/ guardian
approval on waiver.
28 Mile Ride * $10 (Maximum $30 per family)
54 Mile Ride * $10 (Maximum $30 per family)
Minimum age to ride without parent/guardian on 28 & 54
mile rides is 16 years. Requires rider and parent/guardian
approval on waiver. Helmets are required for all riders.
To ensure that you receive your t-shirt on the day of
the ride, you must register by Monday April 18!
Short Sleeve $11 Long Sleeve $13 (Adult Only) In
addition to the registration fee:
Circle One
Adult Long Sleeve
Adult Short Sleeve
Youth Short Sleeve
Youth Sizes (Short Sleeve only) Small Med
Adult Sizes: Small Med Large X-Large
Large
In consideration of the YMCA providing bicycling
opportunities and allowing me/us to participate in it’s
events, I/we release the YMCA and its officers,
directors, members and agents from any and all claims
for death, personal injury, or property damage which
may occur to me/us (or a minor in my care) as a result of
participation in any YMCA activity or event, even though
the claim may arise out of negligence or carelessness on
the part of the persons or entities released.
Signature:______________________________________
Date:__________________________________________
The undersigned parent and natural guardian or legal
guardian does hereby represent that he/she is, in fact,
acting in such a 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 which 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 the
minor and the parents or legal guardian.
Signature:_____________________________________
Date:_________________________________________
This liability must be signed by each participant
at the time of registration.
Register online at www.ymcaofscottsbluff.org
To ensure that you receive your t-shirt on the day of the
ride, you must register by Monday April 18th
Shirt Size: (Optional- $11 short sleeve $13 Long sleeve in addition to fees for
ride) Long sleeve shirts available to adults only
Youth: Small l
Adult: Small
Medium
Medium
Large
Large
X-Large