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City of Clive
Mayor’s Bike Ride with Scott Cirksena
Saturday, July 18th, 2015 at 8:00 a.m.
Bike ride to start & finish at the Clive Aquatic Center parking lot @
1801 NW 114th St., Clive.
Join Mayor Cirksena on a great 21-mile ride that will take you through the Greenbelt and proceed
east on the Walnut Creek and Bill Riley Trails. After turning around at the Gray’s Lake loop, you
then return to the start/finish point at the Clive Aquatic Center. You may also choose to join us for
a family-friendly eight-mile ride on the Greenbelt Trail. Proceeds from the rides will go to
planting trees within the City of Clive.
You can register online at www.cityofclive.com or complete this form and mail with payment
to: Clive Parks and Recreation, 1900 NW 114th St., Clive, IA 50325.
The fee is $10 per person (program #215710-01). The fee includes a one-day
admission to the Clive Aquatic Center for the 2015 season and a raffle ticket.
The raffle will be held Saturday evening for an adult and youth bicycle. Raffle
tickets are $10 and will be sold at the Festival. You need not be present to win.
City of Clive
Parks and Recreation
and
REGISTRATION FORM
Participant or Parent/Guardian (if minor) _____________________________________________________________
Street Address ____________________________________________ City_____________________ Zip____________
Home Phone__________________ Cell Phone___________________ E-mail_________________________________
Emergency Name ___________________________________________ Emergency Phone_______________________
Additional Comments/Medical Information _____________________________________________________________
One family per form. Multiple immediate family members may be registered on same form.
If you are signing up someone outside of your family, a separate form is required in order to enroll.
I hereby agree to indemnify and hold harmless the Clive Parks and Recreation Department and City of Clive, its agents, commissioners, officers, volunteers
and employees (“Released Parties”) from any and all liability for personal injuries or damages I may hereafter sustain while participating in, traveling to or
from, or observing of the Department sponsored activities whether such personal injuries or damages are caused by negligence of the Released Parties
or otherwise, to the full extent permitted by law. I understand that there are inherent risks in participating in this activity. I also give my permission for any
photos/videos of these participants taken during the program to be used for future department promotional materials. The individuals listed on the
registration form have my permission to participate in the listed programs.
Participant or Parent/Guardian (if minor)__________________________________________________________ Date______________________
SIGNATURE REQUIRED
PARTICIPANT NAME(S)
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
Credit Card:  Visa  MasterCard  Discover
Card Number __________________________________________
Exp. Date______/______ Signature ___________________________________________ Check #________________
The fee for the rides is $10.00 per person. Please make checks payable to City of Clive.
2015 Clive Festival Mayor’s Bike Ride