STRIDE Great Race 2015 - STRIDE Adaptive Sports!

STRIDE Great Race 2015
Diana Golden Level I Adaptive Race
Saturday, March 14, 2015
Celebrating 20 Years!!!
Jiminy Peak Mountain Resort
STRIDE Adaptive Sports invites interested athletes to participate in the STRIDE Great Race on March 14,
2015, at Jiminy Peak Mountain Resort in Hancock, MA. The race is an introductory event for disabled
athletes. The open Giant Slalom course is set for entry level skiers and snowboarders to experience racing for the
first time. Racers compete in categories according to their age and disability. Diana Golden Division athletes will
compete in one of three categories: Visually Impaired, Sitting, or Standing. The atmosphere is relaxed and racers
are encouraged to do their best, but most importantly to have fun.
Helmets are mandatory for all racers and available if needed.
After the race, STRIDE volunteers and Boy Scout Troop #537 host a lunch cookout for the racers, families,
and friends located in the courtyard at the base of the lodges. Music, raffle, and auction are part of the festivities,
and we encourage a t h l e t e s t o g e t s p o n s o r s t h r o u g h a F i r s t G i v i n g p a g e !
F amilies can support The Great Race by selling raffle tickets to help STRIDE continue
offering the Race and other adaptive sport programs. Raffle tickets are available from your instructor or
supervisors at your mountain. We also solicit the support of corporate sponsors and donors for the raffle and auction.
Please submit your application and enclosed fees as soon as possible. Feel free to contact our office if you have
questions, and visit the STRIDE.org website for additional information.
$60.00 Race entry fee made payable to STRIDE
ENTRY DEADLINE---MARCH 9, 2015
8:00 AM -9:00 AM Race Registration JJ’s Lodge / Thunderbolt Room Main Floor
GROUP 1
9:00 - 10:30 AM Race Start
GROUP 2 10:30 - 12:00 AM Race Start
12:00 PM
1:00 PM
BBQ Lunch
Awards Ceremony, Raffle & Auction
STRIDE Great Race
Diana Golden Series Level I
Saturday, March 14, 2015
At Jiminy Peak Mountain Resort
RACER REGISTRATION
Name
Age
Address
City
Gender
M
F
Ht
State
Wt_____
Zip
Parent/Guardian (if applicable)
Phone
Email (for race start time)
Race Division:
□
Visually Impaired
□ Cognitive / Intellectual □
3-Track
□
4-Track
□
Bi-Ski / Tethered
□
Mono Skier
□
Dual ski
□
Bi-Ski / Un-tethered
□
Snowboard
$60.00 Entry Fee Includes:
All ski/snowboard equipment (adaptive and rentals); practice runs with coach; 2 runs on the race course
with coach; 1 ticket for awards ceremony and lunch BBQ; registration and goodie bag.
Additional cookout tickets are available in advance for $10.00 each—($12 each on day of event)
Number of additional cookout tickets requested:
_Total enclosed:
This event is designed to introduce adaptive skiers to the thrill and excitement of racing in a safe, fun, and essentially
low-competitive format. Each racer is timed during both runs through a giant slalom course set on beginner terrain,
and special awards are given to the top three finishers in each category. However, every racer is a winner in our
eyes, and medals are presented to every participant during our awards ceremony. Racer divisions will be categorized
by age, disability class and gender.
Helmets are mandatory for all racers and available if needed.
Please enclose a check made out to: STRIDE, Inc.
or provide Mastercard/Visa below with completed form & DSUSA waiver.
Mail or fax to:
STRIDE, Inc., 476 North Greenbush Road #9, Rensselaer, NY 12144
FAX #: 518-391-2563
ENTRY DEADLINE---MARCH 9, 2015
Name
_Signature
Card Number
Amount $
Exp. Date
Please circle:
Visa
MC
DISABLED SPORTS USA INSURANCE WAIVER & RELEASE OF LIABILITY and MEDIA
RELEASE FORM
DISABLED SPORTS USA INSURANCE WAIVER & RELEASE OF LIABILITY FORM
In consideration of being allowed to participate in any way in Disabled Sports USA and STRIDE, Inc. related
events and activities, I and/or the minor participant, for myself, and on behalf of my heirs, assigns, personal
representatives and next of kin, the undersigned:
1. Agree that prior to participating, I will inspect, or if a parent and/or legal guardian I will instruct the minor participant to
inspect, the facilities and equipment to be used, and if I believe, to the best of my ability, that anything is unsafe, I
and/or the minor participant will immediately advise Disabled Sports USA and STRIDE, Inc. of such condition(s) and
refuse to participate.
2. Acknowledge and fully understand that I and/or the minor participant will be engaging in activities that involve risk of
serious injury, including permanent disability and death, and severe social and economic losses which might result only
from my own actions, inactions or negligence of others, the rules of play, or the condition of the premises or any
equipment used. Further, that there may be other risks not known to me or not reasonably foreseeable at this time.
3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent
disability or death.
4. Release, waive, discharge and covenant not to sue Disabled Sports USA and STRIDE, Inc., its affiliated clubs, their
representative administrators, directors, agents, coaches, other employees, and volunteers of the organization, other
participants, sponsoring agencies, sponsors, advertisers, their heirs, and if applicable, owners and leasers of premises
used to conduct the event, all of which are hereinafter referred to as "releasees", from demands, losses or damages on
account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the
negligence of the releasee or otherwise.
5. Acknowledge and fully understand the requirement to use a helmet when participating in the following sports: Alpine
skiing, cycling, equestrian, hockey, outdoor rock climbing, snowboarding, white water kayaking and white water river
rafting. While I understand that helmets are intended to reduce the risk of serious head injury, I accept that no helmet
can fully eliminate or prevent injury to the head, neck, spinal cord, face or any other part of the body. I further recognize
that helmets have limited capability as far as shock absorption and that serious injury or death can result from both low
and high-energy impacts, even when a helmet is worn. I agree that if the helmet is damaged or involved in any kind of
accident, I will stop using it immediately.
I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I/WE HAVE GIVEN UP
SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE NOT CHANGED IT ORALLY, AND SIGN IT
VOLUNTARILY.
X____________________________ _____________________________________
________________
Participant’s Signature Participant's Name (PLEASE PRINT CLEARLY) Date
FOR PARTICIPANTS UNDER THE AGE OF 18 Date of Birth ______________
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree
to his/her release as provided above of the Releasees, and, for myself, my heirs, assigns, and next of kin, I
release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my
minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM
THEIR NEGLIGENCE.
X_____________________ _____________________ _______________ _______________
_________
Parent/Legal Guardian Signature Parent/Legal Guardian Name Relationship Emergency Phone Date
MEDIA RELEASE FORM
MEDIA/PHOTO WAIVER: I hereby authorize and give my full consent to Disabled Sports USA and
STRIDE, Inc. to copyright and/or publish any and all photographs, digital recordings, videotapes and/or film
in which I appear may be used for public view. I further agree that Disabled Sports USA and STRIDE, Inc.
may transfer, use or cause to be used, these digital recordings, photographs, videotapes, or films for any
exhibitions, public displays, publications, commercials, art and advertising purposes, television programs,
and internet without limitations or reservations.
X____________________________ _____________________________________
________________
Participant’s Signature Participant's Name (PLEASE PRINT CLEARLY) Date
FOR PARTICIPANTS UNDER THE AGE OF 18
X_________________________________________________________________
Parent/Legal Guardian Signature Parent/Legal Guardian Name Relationship Emergency Phone Date