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Bike Ride


First Name
Last Name
Address 1
Address 2
Race Day Phone
Emergency Contact

Age on May 17th
Juvenile Co-signer
Price increase
after 3/16/13

100 - $70
75 - $60
50 - $50
25 - $25

Unisex Shirt Size
(first 500 riders)


Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement (“Agreement”)
In consideration for being permitted to participate in any way in CASA River Century on May 18, 2013, an event sponsored by CASA of the Eastern Panhandle, Inc. I, myself, my personal representatives, assign heirs and next of kin:

1. Acknowledge, agree and represent that I understand the nature of bicycling activities and that I am qualified to participate in such activity. I further acknowledge that the activity will be conducted over public roads and facilities to be open to the public during the activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the activity.
2. Fully understand that a) bicycling activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis and death (“risks”); b) these risks and dangers may be caused by my own actions, or inactions of others participating in the activity, the condition in which the activity takes place, or the negligence of the “releases” named below; c) there may be other risks and social and economic losses either known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for all losses, costs, damages I incur as a result of my participation in the activity.
3. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless CASA of the Eastern Panhandle, Inc., its administrators, directors, ride leaders, volunteers, agents and employees, other participants, any sponsors, advertisers, and if applicable, owners and releasers of premises on which the activity takes place (each considered on e of the “releases” herein) from all the liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or part by the negligence of the “releases” or otherwise, including negligent rescue operations.
I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held invalid the balance, notwithstanding, shall continue in full force and effect.

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Important Files
Donation Letter (DOC | PDF)
Sponsorship Form(DOC | PDF)
Important Links
Registered Riders
Donate to CASA
Event Schedule