Participants Name __________________________________ Address _____________________________ City, state, zip ________________________________ Telephone # _____________ email address _________________________ |
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RELEASE FORM AND ASSUMPTION OF THE RISK AGREEMENT The undersigned (on my own behalf and on behalf of my heirs, personal representatives, successors and assigns), for and in consideration of the opportunity to participate in the United Way of Northeastern Minnesota's (UWNEM) "Winter Blast 2010 Snowmobile Ride", hereby releases and forever discharges the above named entity, its officers, event sponsors, employees and volunteers from any claims, demands, rights and causes of action of any kind whatsoever, which I now have or later may have in any way resulting from, or arising out of or in connection with my participation in said event. I agree that I am eligible to drive a snowmobile under the Minnesota DNR laws. I further agree that while participating in the event I will not be under the influence of alcohol or any substance that affects the ability to operate or control my vehicle. I will not use or operate any vehicle in violation or contravention of any City, County, State or Federal laws, statutes, ordinances or regulation and shall be personally liable for all fines and penalties for traffic law violations. I hereby state that I am experienced in and familiar with the operation of various snowmobiles and fully understand the dangers inherent in snowmobiling. I am voluntarily participating in UWNEMN "Winter Blast 2010 Snowmobile Ride" and I expressly assume the entire risk of any accidents or personal injury, including death, which I might suffer as a result of my participation in the event whether such risk results from negligence (except willful neglect) on any part of any or all of the released parties. (I state that I have read the referenced route map and expressly agree to assume the entire risk associated with proceeding on this route.) I agree to wear minimum safety apparel as required by state law. The participant is strongly advised to wear a helmet whether required by law to do so or not, and is strongly advised to wear glasses, goggles or a face shield, and additional protective outerwear while participating in the event. The participant understands that failure to wear proper safety apparel may result in the participant's injury or death. I additionally state that I participate in these events knowing that weather conditions, road conditions, and other similar conditions, factors and circumstances associated with these events may vary which may give rise to injuries I incur. By signing this release, I certify that I have read this Release and fully understand it and that I am not relying on any statements or representations of anyone released thereby. ______________________________________________________________________ Signature of Participant Date
229 W. Lake Street Chisholm, MN 55719 (218) 254-3329 |
 United Way of Northeastern Minnesota |
 Fortune Bay Resort Casino |