Sign Up to Ride!

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Join us! Sign up here to a part of the Broadleaf Bikes 2021 Ride. You'll receive a few emails from us with information about the ride, ways to participate, and a link to set up a personal fundraising page if you'd like.

Untitled Title

First Name *

Last Name *

Email Address *

Phone Number

Street Address

City

State

Zip Code

Waiver *

I acknowledge that in undertaking the bike ride to raise money for the benefit of Broadleaf Health and Education Alliance occurring June 26, 2021 I assume all risks, which are foreseeably involved with or arise out of my voluntary participation in the bike ride. I hereby release Broadleaf Health and Education Alliance and all of its officers, employees and agents on account of or in connection with any claims, causes of action or injuries, illnesses or damages from costs and expenses arising out of the bike ride undertaken to raise money for Broadleaf Health and Education Alliance. I understand that Broadleaf does not carry insurance covering possible losses that the I may incur as a result of his or her voluntary participation in the bike ride. I understand that I am encouraged to have a medical physical examination and purchase health insurance prior to the participation in this bike ride.

Required

Clear form

Never submit passwords through Google Forms.

This form was created inside of Broadleaf Health and Education Alliance. Report Abuse

Forms