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Name Date: By Rail, Road, Rein or River $25 Registration Fee. Please choose your trail bellow: 1) By Rail Transcontinental Railroad: 3,560 miles (round trip) Prize: $500 Cody Bucks 2) By Road Route 66: 2,448 miles Prize: $350 Cody Bucks 3) By Rein The Pony Express: 1,966 miles Prize: $250 Cody Bucks 4) By River The Yellowstone River: 678 miles Prize: $100 Cody Bucks T- Shirt Size (Check One) - - - - - - - - - - S M L XL 2XL ***You must choose your trail BEFORE you accumulate miles; if you change your trail at any time during the challenge, you will start fresh accumulating miles*** Please read this waiver carefully, and let us know if you have any questions or concerns. When registering yourself, your spouse, or your minor child(ren) for membership and participation in activities and programs sponsored by the Paul Stock Aquatic & Recreation Center you will be waiving and realizing all claims for injuries you, your spouse, or your minor child(ren) might sustain arising out of the use of the facility mentioned above. I hereby give my consent for myself, spouse or minor child(ren) to participate in recreational activities sponsored by the Cody Parks & Recreation Department in Cody, Wyoming during any session of the recreation program. I hereby release the Shoshone Recreation District, Recreation Director, Recreation Staff and Board of Directors, the Cody Parks & Recreation Department, the City of Cody, and all City staff associated therewith from all liability, including claims and suits at law or in equity for any injury fatal or otherwise, while participating in any of the recreation activities and understand that I will be fully responsible for any damage or injuries incurred by the participant while involved in any Recreation Department activity. Also, I hereby pledge to provide positive support, care and encouragement for my fellow competitors and league officials by following this Code of Ethics. I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game. I will treat other players, coaches, fans and officials with respect regardless of race, sex, creed or ability. I understand that I am participating in a recreation activity and agree not to use profane language or engage in ‘trash talking’ at any time. I will lead, by example, in demonstrating fair play and sportsmanship to all my fellow competitors. I understand that the officials are there for my benefit and will agree not to direct any profane or threatening actions toward them (either verbal or physical). I understand that any violation of this code shall be cause for the Shoshone Recreation Board & Cody Parks & Recreation, in executive session, to deal with any behavior and/or conduct that are considered by the Board to be disruptive, destructive, and/or illegal. Behavioral problems may result in expulsion from the program without reimbursements. The Shoshone Recreation District/Cody Parks & Recreation Department does not provide any medical insurance or personal liability to cover participants during an activity. This is the responsibility of each individual involved in any recreation activity. All purchased memberships are non-transferable and non-refundable. All purchases are subject to our return policy. Print Name: Signature of Primary Member: Paul Stock Aquatic and Recreation Center Cody Parks, Recreation and Public Facilities 1402 Heart Mountain Street P O Box 2200 Cody, Wyoming 82414 (307) 587-0400 U:\FRONT DESK\FORMS AND FLYERS\REG FORM REV C Code 160399-1 MEMBERSHIP AND ACTIVITY WAIVER TRIP CHALLENGE 2013 SIGN