Please fill out every applicable field in the form below.

Consent for Use of Personal Information and Release, Waiver, and Assumption of Risk must be checked off below in order for us to process your registration.

Be sure to also have an MCA license (available here) to race at the Bur Oak Series races, and most other MCA sanctioned events.

Please note that online registration closes 24 hours before each race.  To register after that time please download a printable form and bring to race.

Bur Oak Event Date:

  Full Race Series, $35 for all six races (save money by paying for the full series in advance)

  Race #1, Wednesday April 23rd, 2008, $10

  Race #2, Wednesday May 7th, 2008, $10

  Race #3, Wednesday May 28th, 2008, $10

  Race #4, Wednesday June 25th, 2008, $10

  Race #5, Wednesday July 16th, 2008, $10

  Race #6, Wednesday Aug 13th, 2008, $10

Race Category: (go to the MCA site for a description of race categories)

  Citizen

  Sport

  Comp

  Expert

  Elite / Espoir

Personal Info:

First Name     Last Name   

City     Province / State    

Postal Code / Zip 

Phone      Email 

Date of Birth: day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   month jan feb mar apr may jun jul aug sep oct nov dec   year 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000    Club Name (if applic.)

Gender: Male Female

Emergency Contact Name: Emergency Contact Phone:     

Payment: 

Visa MasterCard American Express  

Credit Card #:    Expiry: mm 01 02 03 04 05 06 07 08 09 10 11 12 yy 08 09 10 11 12 13 14 15 16 17 18

*Please remember that a Provincial Park Pass is required to enter Bird's Hill Park - available at Canadian Tire and other retailers.

CONSENT FOR USE OF PERSONAL INFORMATION: 

I understand Olympia Cycle & Ski gathers personal information including but not limited to name, address, email, sex, age, and birthdate of each of its participants as well as video and picture images of each of its participants.  This information is used for such purposes as ensuring that each participant competes in the appropriate category, and that their results will be accurately posted on our website and elsewhere. Other participant information and images may be acquired before, during, and/or after the event and used to promote the event on our website, in print, and elsewhere.  I am aware that by giving this consent, I am permitting personal information about me to be used by Olympia Cycle & Ski.

Check the box if you agree to the above consent for use of personal information.

Release, Waiver and Assumption of Risk:

I, (please type full name into box) hereby acknowledge and agree that in consideration of being permitted to participate in the Wednesday Night Bur Oak Race Series and by checking the box at the end of this online form, I am releasing Olympia Cycle & Ski, their respective agents employees, members, sponsors, promoters and affiliates (collectively 'releasees'), and the land owner(s) of property being used from liability recourse, proceedings, claims, and causes of action of any kind whatsoever, in respect of all personal injuries or property losses which I may suffer arising out of or connected with my preparation for, or participation in, the Wednesday Night Bur Oak Race Series notwithstanding that such injuries or losses may have been caused solely or partly by the negligence of the Olympia Cycle & Ski or any of their members, officers, directors, employees, independent contractors, agents, affiliated clubs, and volunteers.

And, I hereby acknowledge and agree:

That the sport of cycling is very dangerous, exposing participants to many risks and hazards, some of which are inherent in the very nature of the sport itself, others which result from human error and negligence on the part of the persons involved in preparing, organizing and staging cycling programs, races and other activities;

That, as a result of the aforesaid risks and hazards, I as a participant may suffer serious personal injury, even death, as well as property loss;

That some of the aforesaid risks and hazards are foreseeable, but others are not;

That I nevertheless freely and voluntarily assume all the aforesaid risks and hazards, and that, accordingly, my preparation for, and participation in the aforesaid cycling events and activities shall be entirely at my own risk;

That I understand that neither Olympia Cycle & Ski nor any of their members, officers, directors, employees, independent contractors, agents, affiliated clubs or volunteers assume any responsibility whatsoever for my safety during the course of my preparation for or participation in the aforesaid cycling programs, races and activities;

That I have carefully read this RELEASE, WAIVER, AND ASSUMPTION OF RISK agreement, that I fully understand same, and that I am freely and voluntarily executing same;

That I understand clearly that by checking the box at the end of this release I will be forever prevented from suing or otherwise claiming against Olympia Cycle & Ski, their members, officers, directors, employees, independent contractors, agents, affiliated clubs or volunteers, and the land owner of property being used, for any loss or damage connected with any property loss or personal injury that I may sustain while participating in or preparing for any of the above mentioned cycling programs, races or activities whether or not such loss or injury is caused solely or partly by the negligence of Olympia Cycle & Ski or any of their members, officers, directors, employees, independent contractors, agents, affiliated clubs or volunteers;

That I have been given the opportunity and have been encouraged to seek independent legal advice prior to signing this agreement;

That I understand clearly that Olympia Cycle & Ski would not permit me to participate in any such cycling programs, races and activities unless I checked the box at the end of this RELEASE, WAIVER, AND ASSUMPTION OF RISK AGREEMENT.

That this RELEASE, WAIVER, AND ASSUMPTION OF RISK agreement, enacted by checking the box at the end of this agreement,  is binding on myself, my heirs, my executors, administrators, personal representatives and assigns.

BY CHECKING THIS BOX AND SUBMITTING THIS FORM, I ACKNOWLEDGE HAVING READ, UNDERSTOOD AND AGREED TO THE ABOVE CONSENT FOR USE OF PERSONAL INFORMATION and Release, Waiver and Assumption of Risk for the Bur oak Wednesday night race series AND HAVE EXECUTED THIS AGREEMENT VOLUNTARILY.

(please type full name)

day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   month jan feb mar apr may jun jul aug sep oct nov dec   2008  (please select today's date)

Consent and release of Parent or Guardian:

(if participant is under 18 years of age at the date of submitting this document)

I (please type full name) am the parent or guardian of (please type full name of child). My child is fit for the event, and I consent to my child's participation. I have read and I understand the registration form and release agreement. In consideration of allowing my child to participate, I consent to it and agree that its terms shall likewise bind me, my child, my heirs, legal representatives, and assignees. I hereby release and shall defend, indemnify and hold harmless the releasees from every claim and any liability that I or my child may allege against the Releasees (including reasonable attorneys fees or costs) as a direct or indirect result of injury to me or my Child because of my Child's participation in the event, whether caused by the negligence of the Releasees or others. I promise not to sue the releasees on my behalf or on behalf of my child's regarding any claim arising from my child's participation in the event.

(please click the Submit button once only - processing may take a few seconds)