PHILADELPHIA

ROMANIAN PENTECOSTAL CHURCH

ACCIDENT WAIVER & RELEASE OF LIABILITY FORM

NAME OF ACTIVITY OR EVENT: REVEAL SUMMER BIKE RIDE 2017

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATION AND/OR VOLUNTEERING IN THIS ACTIVITY
OR EVENT, including any risks that may arise from negligence or carelessness on the part of the persons
or entities being released, from dangerous or defective equipment or property owned, maintained, or
controlled by them, or because of their possible liability without fault.

I certify that there are no health-related reasons or problems, which preclude my participation in this
activity or event.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders,
sponsors, and organizers of the activity or event in which I may participate, and that it will govern my
actions and responsibilities at said activity or event.

I WAIVE, RELEASE, AND DISCHARGE from any and all liability arising from the negligence or fault of the
entities or persons released, for my death, disability, personal injury, property damage, property theft, or
actions of any kind which may hereafter occur to me including my traveling to and from this event.

I INDEMNIFTY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this
Philadelphia Romanian Pentecostal Church activity from any and all liabilities or claims made as a result
of participation in this activity or event, whether caused by the negligence of release or otherwise.

I acknowledge that this activity or event may involve risks caused by terrain, facilities, temperature, and
weather condition of participants, equipment, and vehicular traffic actions of other people and lack of
hydration.

I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury,
accident, and/or illness during this activity or event.

The accident waiver and release of liability shall be construed broadly to provide a release and waiver to
the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT.
I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN
FREE WILL.


PRINT Participants Name and AGE


Signature [if under 18 years old, parent or guardian must also sign] DATE


INSURANCE INFORMATION NAME OF COMPANY POLICY NUMBER


EMERGENCY CONTACT NUMBER NAME RELATIONSHIP
 Philadelphia Romanian Pentecostal Church to 1100 NW 11th Ave, Portland, OR Bicycle 13.3 miles, 1 h 11 min
97209

Map data 2017 Google United States 5000 ft

Philadelphia Romanian Pentecostal Church

Philadelphia Romanian Pentecostal Church
5544 SE 128th Ave, Portland, OR 97236 Use caution - may involve errors or sections not suited for bicycling

1. Head south on SE 128th Ave toward SE Ellis St

394 ft

2. Turn right onto Springwater Corridor Trail

2.6 mi
3. Slight right to stay on Springwater Corridor Trail
3.6 mi
4. Turn right toward SE Linn St
210 ft

5. Turn left onto SE Linn St

0.6 mi

6. Slight right onto Springwater on the Willamette

0.9 mi

7. Slight right to stay on Springwater on the Willamette

2.6 mi

8. Continue onto SE 4th Ave

0.1 mi
9. Turn left onto SE Caruthers St
0.1 mi

10. Continue onto Eastbank Esplanade

0.1 mi

11. Slight right to stay on Eastbank Esplanade

1.0 mi
12. Turn left to stay on Eastbank Esplanade
0.5 mi

13. Continue onto Steel Bridge Lower Deck

0.2 mi
14. Turn right
197 ft

15. Turn right toward NW Naito Pkwy

Partial restricted usage road
0.3 mi
 16. Turn left toward NW Naito Pkwy
Restricted usage road
259 ft
17. Turn right onto NW Naito Pkwy
0.4 mi
18. Turn left onto NW 9th Ave
269 ft

19. Turn right onto NW Overton St

0.1 mi
20. Turn right onto NW 11th Ave
Restricted usage road
Destination will be on the right
262 ft

1100 NW 11th Ave

Portland, OR 97209

These directions are for planning purposes only. You may nd that construction projects, tra c, weather, or other events
may cause conditions to differ from the map results, and you should plan your route accordingly. You must obey all signs
or notices regarding your route.