Bike Rodeo Registration Form

I consent that the below mentioned participants are given permission to participate in PennDOT's Bike Rodeo. I do this with full knowledge that they must be wearing a proper bike helmet and that riding a bike and participating in the prepared events has an inherit risk of crashes and accidents. I will not hold PennDOT or any of the affiliated partners responsible for any injuries that may occur.

Participant Information

Parent/Guardian Information

Photo Release

I hereby consent to the Commonwealth of Pennsylvania, Department of Transportation (“PennDOT”), using my likeness, including but not limited to, my name, signature, photograph, image, voice, or a substantially similar imitation of one or more thereof. I hereby consent to PennDOT recording or reproducing my likeness in any media. I consent to PennDOT being the exclusive owner of any intellectual property rights as they relate to any original material it creates by utilizing my likeness. I agree to indemnify PennDOT and its agents and contractors (including photographers or videographers) from any and all claims as they relate to the use of my likeness. I agree this release shall be effective as of the date of signature below and remain in effect indefinitely, including following my termination of employment from PennDOT. I have read and fully understand this release and intend to be legally bound by its terms.

Electronic Submission. Under penalties of perjury I certify that I am the person accessing this web page and submitting the Department of Transportation. By selecting I Agree and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be prosecuted if I provide false or misleading information. RELEASE OF INFORMATION: I verify that the information provided in this document is true and accurate. I understand that I may be subject to the criminal penalties prescribed by 18 Pa. C.S.A. Section 4904 for unsworn falsifications to authorities if there are false statements in this document.