I have volunteered to be a driver for the BIAC/Pikes Peak Challenge on Saturday, September 7, 2024. In lieu of presenting a copy of my driving record, I declare that I have not had any Driving under the Influence, Driving While Intoxicated, Reckless Driving or any other violations that have accumulated 6 or more points against my license in the past three years, nor have my driving privileges been suspended or revoked.

I acknowledge and agree that weather conditions may be hazardous on the Pikes Peak Highway during the Pikes Peak Challenge. I hereby release and hold blameless from all claims or liabilities of any kind the BIAC Pikes Peak Challenge, the Brain Injury Alliance of Colorado, U.S. Forest Service, The City of Colorado Springs, sponsors, or any staff for any injury I may suffer. I assume responsibility for emergency medical care and transportation off of Pikes Peak by ambulance or helicopter.

In the event of an emergency, accident or illness, I hereby give permission to be treated by professional medical personnel and to be admitted to a hospital, if necessary. I give consent for any emergency procedure or treatment, which may be necessary, including medical transportation by ambulance, helicopter or other means. I agree to be the party responsible for any and all medical transportation, all medical expenses, which are incurred on my behalf.

I hereby acknowledge that the BIAC Pikes Peak Challenge staff, its agents, sponsors and all other parties involved are under no obligation to provide medical care in the event of an accident or illness. Therefore, in the event that I do receive medical care as a result of medical emergency, I consent to such and fully release the persons providing such from any and all liability, whether resulting from negligence, omission or otherwise.

In acknowledgement of the possible dangers and risks of volunteering for the BIAC Pikes Peak Challenge, which I assume unconditionally, I hereby state that my general health is good except as qualified on the medical information portion of this form, and that I am capable of performing the physical activities in order to volunteer for the BIAC Pikes Peak Challenge.

I grant full permission for organizers to use photographs or video clips, sound or quotations from me in legitimate accounts and promotions of this event.

I agree to all of the terms and conditions set forth above.