Red Door Rail Jam 2018

Registration and Release of Liability Form
To be comleted by all participating individuals.

Participant Information

First Name: Last Name:
Full Address: Phone:
Email: Credit Card # ($25): Exp. Date:

Emergency Contact

First Name: Last Name:
Full Address: Phone:
Relationship to Rider:    


Physical Condition

I am physically fit to participate in the Red Door Rail Jam in which I have chosen to participate, and have not been advised otherwise by a medical practitioner.

Photo/Image Release

I hereby authorize, The Red Door Lounge to use, reproduce, and/or publish photographs and/or video that may pertain to me— including my image, likeness and/or voice without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs) or for other related endeavors. This material may also appear on the Red Door's Internet Website.

Liability Release

By clicking Submit below I verify that I am eighteen years of age or older and have voluntarily applied to participate in activities for the organization listed above. I acknowledge that the nature of my participation in this event may expose me to hazards or risks that may result in my illness, personal injury or death and I understand and appreciate the nature of such hazards and risks.

In consideration of my participation, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release The Red Door Lounge, their governing boards, officers, employees and representatives from any and all liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation, whether caused by negligence of The Red Door Lounge their governing boards, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless The Red Door Lounge their governing boards, officers, employees, and representatives from liability for the injury or death of any person(s) and damage that may result from my negligent or intentional act or omission while participating.

I UNDERSTAND AND ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS RELEASE OF LIABILITY AND UNDERSTAND ITS CONTENTS. I UNDERSTAND THAT BY CLICKIN SUBMIT BELOW EXPRESSLY WAIVES ANY RIGHTS I HAVE TO BRING A CLAIM AGAINST OR SUE THE RELEASEES FOR INJURIES OR DAMAGES. I FURTHER UNDERSTAND THAT THIS IS A CONTRACT THAT LIMITS MY LEGAL RIGHTS AND THAT IT IS BINDING UPON ME, MY HEIRS, AND LEGAL REPRESENTATIVES. I UNDERSTAND MY CREDIT CARD WILL BE CHARGED FOR $25.

YOU WILL RECEIVE A CONFIRMATION EMAIL LETTING YOU KNOW YOUR REGISTRATION IS CONFIRMED. YOU ARE NOT REGISTERED UNTIL YOU HAVE A CONFIRMATION EMAIL.