Bike MS: Texas MS 150

Bike MS: Texas MS 150

Who: Family (ages 12+)

What: A 2-day charity event organized by Multiple Sclerosis Association of America where cyclists come together for a biking journey to raise awareness and funds for MS!

When: April 29-30, 2023 | Saturday & Sunday

Where: Option 1: Houston - La Grange - College Station
Option 2: Austin - La Grange - College Station

How: Two step registration:

1. Register with MS150: https://mssociety.donordrive.com/index.cfm?fuseaction=register.start&eventID=1270

2. Complete the AKYSB form and waiver below. AKYSB fees will be collected at a later date to accommodate logistics.
Participant Information

Please provide the participant's information below.
Name Name First Last
City, State
Zip Code
Must be 5 digits. Currently Entered: 0 digits.
Phone Number Phone Number - ### - ### ####
Email
Date of Birth Date of Birth / MM / DD YYYY
Age
Must be a number between 12 and 100
Jamatkhana
Gender

Gender Female Male
Jersey Size
Emergency Contact Name Emergency Contact Name First Last
Emergency Contact Relationship
Emergency Contact Phone Number Emergency Contact Phone Number - ### - ### ####
Are you a first time rider?

Are you a first time rider? Yes No
Have you registered for the official MS150 ride?

Have you registered for the official MS150 ride? Yes No
Do you currently own a bike?

Do you currently own a bike? Yes No
If you answered 'Yes' to the question above, then what model and type of bike (mountain, road, etc) do you own? If no, then put 'N/A'.
Do you consider yourself to have an active lifestyle?

Do you consider yourself to have an active lifestyle? Yes No
Rate your skill level.

Rate your skill level. Beginner: I know how to ride a bike. Intermediate: I ride a bike regularly. (Comfortable riding 10-20 miles) Advanced: I ride a bike regularly and have participated in biking events. (Comfortable riding 20-30 miles)
Please describe your biking experience.
Do you have food restrictions?

Do you have food restrictions? Yes No
If you answered 'Yes' to the question above, then please list your food restrictions or any allergies? If no, then put 'N/A'
How did you hear about the AKYSB MS 150 event?

How did you hear about the AKYSB MS 150 event? Social Media WhatsApp Email Friend or Family Member Jamatkhana Announcement Other Other
CONSENT AND RELEASE FORM

To be completed by the participant (18 years or older)

I, [Type Name Below], in exchange for being given the opportunity to participate in AKYSB BIKE MS 150 (the “Activity”), hereby give consent and permission for myself to attend and participate in the Activity on the following date(s): April 29, 2023 to April 30, 2023.

I, on behalf of myself, my heirs, successors, assigns, and any other persons or entity claiming through or under any of them, waive my right to sue and hereby RELEASE, INDEMNIFY, and HOLD HARMLESS His Highness Prince Aga Khan Shia Imami Ismaili Council for the Southwestern United States (the “Council”), its regional/local councils, boards, portfolios, members, staff, volunteers, representatives and agents, including but not limited to the organizers, counselors and staff associated with the Activity (collectively, the “Indemnitees”) from and against any and all losses, claims, damages, causes of action, liabilities, costs, and expenses which may be asserted against the Indemnitees, if any, of every nature whatsoever, known or unknown, which arise out of or are connected with (1) any damages to person or property as a result of my participation or any other person's participation in the Activity; (2) any injury or death, including that arising, in part or whole, from the sole or contributory negligence of the Indemnitees, occurring during or related to the Activity and/or any travel which participation in the Activity may involve; (3) any policies, procedures, conduct, or negligent act or omission of the Indemnitees; and (4) any injury I may suffer due to the Activity or due to the facility where the Activity is taking place.

I hereby consent and grant permission to the Council and its Indemnitees to take photographs, videos, make recordings, and other media coverage (collectively, the “Captured Content”) of myself at or during the Activity, and to use, post or publish the Captured Content in various publications including but not limited to the internet, social media, newspapers, magazines, other print media, and marketing materials. I hereby disclaim any rights to and in such Captured Content, and release the Council and its Indemnitees from any claims, damages or liability relating to same.

I hereby consent to any medical or surgical treatment which I may need and which arises in connection with the Activity; provided, however, nothing contained herein shall be deemed an obligation on the Council or its Indemnitees to provide any such medical or surgical treatment. I understand that the Council and Indemnitees do not carry healthcare insurance that covers me and therefore, I am solely responsible for the cost of all medical and surgical treatment.

I explicitly agree that any transportation required to and from the Activity shall be undertaken solely at my own risk.

Any controversy or claim arising out of or relating to the Activity or this Consent & Release Form shall be settled by binding arbitration administered by the His Highness Prince Aga Khan Shia Imami Ismaili Conciliation and Arbitration Board for the United States of America, and its decision shall be final and binding on all parties.

I acknowledge that should any part of this Consent & Release form be determined to be invalid or without full legal effect, such determination shall not invalidate the remaining portions thereof, which shall remain in full force and effect.

I HAVE READ AND VOLUNTARILY SIGN THIS CONSENT & RELEASE FORM AND INTEND IT TO BE A COMPLETE, FULL AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
CONSENT AND RELEASE FORM

To be completed by the parent or guardian of the participant:

I, the aforementioned Parent/Guardian, in exchange for my child being given the opportunity to participate in AKYSB BIKE MS150 (the “Activity”), hereby give consent and permission for my son/daughter, (the “Participant”) to attend and participate in the Activity on the following date(s): April 29, 2023 to April 30, 2023.

I, on behalf of myself, my spouse, if applicable, the Participant, and my heirs, successors, assigns, and any other persons or entity claiming through or under any of them, waive my right to sue and hereby RELEASE, INDEMNIFY, and HOLD HARMLESS His Highness Prince Aga Khan Shia Imami Ismaili Council for the Southwestern United States (the “Council”), its regional/local councils, boards, portfolios, members, staff, volunteers, representatives and agents, including but not limited to the organizers, counselors and staff associated with the Activity (collectively, the “Indemnitees”) from and against any and all losses, claims, damages, causes of action, liabilities, costs, and expenses which may be asserted against the Indemnitees, if any, of every nature whatsoever, known or unknown, which arise out of or are connected with (1) any damages to person or property as a result of the Participant’s participation or any other person's participation in the Activity; (2) any injury or death, including that arising, in part or whole, from the sole or contributory negligence of the Indemnitees, occurring during or related to the Activity and/or any travel which participation in the Activity may involve; and (3) any policies, procedures, conduct, or negligent act or omission of the Indemnitees; and (4) any injury I or the Participant may suffer due to the Activity or due to the facility where the Activity is taking place.

I hereby consent and grant permission to the Council and its Indemnitees to take photographs, videos, make recordings, and other media coverage (collectively, the “Captured Content”) of the Participant or myself at or during the Activity, and to use, post or publish the Captured Content in various publications including but not limited to the internet, social media, newspapers, magazines, other print media, and marketing materials. I hereby disclaim any rights to and in such Captured Content, and release the Council and its Indemnitees from any claims, damages or liability relating to same.

I hereby consent to any medical or surgical treatment which the Participant may need and which arises in connection with the Activity; provided, however, nothing contained herein shall be deemed an obligation on the Council or its Indemnitees to provide any such medical or surgical treatment. I understand that the Council and Indemnitees do not carry healthcare insurance that covers the Participant and therefore, I am solely responsible for the cost of all medical and surgical treatment.

I explicitly agree that any transportation required by the Participant to and from the Activity shall be undertaken solely at my own risk.

Any controversy or claim arising out of or relating to the Activity or this Consent & Release Form shall be settled by binding arbitration administered by the His Highness Prince Aga Khan Shia Imami Ismaili Conciliation and Arbitration Board for the United States of America, and its decision shall be final and binding on all parties. I acknowledge that should any part of this Consent & Release form be determined to be invalid or without full legal effect, such determination shall not invalidate the remaining portions thereof, which shall remain in full force and effect.

I HAVE READ AND VOLUNTARILY SIGN THIS CONSENT & RELEASE FORM AND INTEND IT TO BE A COMPLETE, FULL AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Print Participant Name
Print Parent/Guardian Name
Today's Date Today's Date / MM / DD YYYY

Bike MS: Texas MS 150

Bike MS: Texas MS 150

Participant Information

CONSENT AND RELEASE FORM

CONSENT AND RELEASE FORM