I hereby absolve the State of Vermont, its officials and employees from any responsibility or liability resulting from a bike climb on July 26, 2003 at Ascutney State Park, Windsor, Vermont. The undersigned, as an individual, do hereby release the State of Vermont, its officials and employees, from any and all liability from any injury or death or said liability which may result from said event.

_______________________________________
Print Name (clearly)

_______________________________________
Signature