Bubba’s Pampered Pedalers Pampering …

1 bubba s Pampered Pedalers Pampering registration form please Type or Print Clearly Remember to use Sun Screen Melanoma KILLS Name of Event:_____ Dates of Event::_____ Pampered Rider One: Name: _____ Cell Phone_____:_____ Email Address::_____ Pampered Rider Two Name: _____ Cell Phone: ____-_____ Email Address: _____ Pampered Rider Three Name: _____ Cell Phone: ____-_____ Email Address: _____ Tent choices: bubba is proud to offer two sizes of top quality Kelty tents. The regular tent will accommodate one twin size mattress (one person) or one queen size mattress (two people). The bubba Dome is a really large tent which can accommodate two twin size mattress or one a queen size mattress. The bubba Dome also allows you the opportunity stand and move about. The bubba Dome is a very popular upgrade. Single in a Regular Tent: ____$395 Single in a bubba Dome: ____ $510 Double in a Regular Tent with one Queen Mattress: ____ $540 Double in bubba Dome with TWO Twins ____$680 Double in bubba Dome with one Queen Mattress ____ $680 Three in bubba Dome (One Queen and One Twin ____$820 Mail registration and check to: bubba Barron 292157 Tampa, FL.)

2 33687 Deposit: A minimum of 50% deposit is required at time of booking with the remaining due at check-in. Cancellation Policy: A $175 cancellation fee will be applied if the cancellation is received before one month from the start of the event. Sorry, no refunds will be given for cancellations less than one month from the starting date. This cancellation policy must/will be enforced. please do not ask for an exception. Trip insurance is available through various sources. We will assist in filing a claim if needed. registration form must be signed by each rider. Signature of rider number one: _____ Signature of rider number two: _____ Signature of rider number three: _____ Waiver must be signed by each rider and enclosed for registration to be processed. bubba s Pampered Pedalers Waiver and Release please read this carefully.

3 This is a contract with legal consequences. I, the undersigned, know that services offered by bubba s Pampered Pedalers is a potentially hazardous event, and attend it out of my own free will and choice. In choosing to bubba s Pampered Pedalers and any related events or activities, I fully accept and assume all risks, whether before, during or after services of bubba s Pampered Pedalers and/or related events or activities. These include, without limitation, risk of physical injury mental injury, mental stress, emotional stress, trauma, death, contact with other participants, equipment failure, inadequate safety equipment, effects of weather including extreme temperature or conditions, traffic, contact with motor vehicles of all types and descriptions, collision with other riders or fixed or moving objects, the conditions of the roads, theft, damage or theft to vehicle whether on event or parked at long term parking area, camping and participating in events or activities along the route.

4 All risks are known, understood, and appreciated by me. I waive any and all specific notice of the existence of risks. I agree that leaders and maps are provided for my convenience only and do not guaranty a safe route or trip. I shall assume and pay my medical and emergency expenses in the event of injury, illness or other incapacity regardless of whether I authorized such expense. I realize services offered by bubba s Pampered Pedalers requires physical conditioning and I represent that I am in sound medical condition capable of participating in the ride without risk to myself or others. I have no medical impediment that would endanger me or others. I understand that situations may arise while receiving services from bubba s Pampered Pedalers that may be beyond the control of sponsors, promoters and organizers.. Knowing these facts and in consideration of my entry, acceptance, admission to and participation in services offered by bubba s Pampered Pedalers and its related events and activities, I, for myself and anyone acting on my behalf, waive, release, discharge, indemnify, covenant not to sue and agree to hold , bubba s Pampered Pedalers and/or the staff of bubba s Pampered Pedalers , any and all sponsors, communities, cities, towns, counties, and states, organizations, bubba s Pampered Pedalers employees-representatives-volunteers-age nts-insurers-insurance brokers and successors of all above, harmless from any and all claims, demands and actions of any and every kind that I have, may have or may hereafter accrue against the released parties, directly or indirectly, arising out of or relating in any respect to my attendance or participation in services offered by bubba s Pampered Pedalers , and its related events and activities.

5 Including, without limitation, litigation expenses, attorney fees, loss liability, damages or cost. My waiver and release of all claims, demands, actions and liability shall include, without limitation, any injury, damage or loss to my person or property which may be caused by any act, or failure to act, by the above identified persons and entities or sustained by me before, during or after the services offered by bubba s Pampered Pedalers and its related events and activities. I agree to abide by all bubba s Pampered Pedalers regulation. I waive my rights of privacy or publicity and grant permission to all of the forgoing to use any photographs, motion pictures, videotapes, recordings or other record of this event for any legitimate purpose. I further agree to indemnify and hold the parties released above harmless from any and all losses, damages, claims and expenses, including attorney fees, arising from or relating in any respect to my participation in in services offered by bubba s Pampered Pedalers or its related events and activities.

6 If I am a minor, my parent or guardian is also signing on my behalf and we both agree to be bound by the same terms of this agreement, waiver and release. If I am the parent or legal guardian of a minor child participant, I certify that the minor is in good health, qualified and in proper physical condition to participate in services offered by bubba s Pampered Pedalers and I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless all of the above released parties from all liability, claims, demands, losses or damages on the minor s account incurred in connection with in services offered by bubba s Pampered Pedalers or its related events and activities. I will indemnify, save and hold harmless each of the released parties from any litigation, expenses, attorney fees, loss liability, damage or cost that may occur as the result of any such claims in connection with the minor s participation and its related e in services offered by bubba s Pampered Pedalers events and activities.

7 _____ _____ Signature (signature of parent or guardian if under 17 years of age) Print Full Name Waiver must be signed and dated in order to attend this event _____ Date