Bennington County 
Child Advocacy Center & Special Investigations Unit 

Bennington County Association Against Child Abuse 

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Thank you to our community for such wonderful support!

Registration Form: Print off and complete. 

Each Rider must have a completed Registration Form and signed Waiver.

Please Print

Last Name __________________________________ Age as of 10/1/17: ______________

First Name __________________________________

Address   _____________________________________________________________________

_____________________________________________________________________________

Email ______________________________                Phone ____________________________

Team/Family Rider Name _________________________________

Emergency Contact: _____________________________________________________  Contact Phone: ____________________________


In consideration of the acceptance of this entry, I hereby for myself, my heirs, my executors and administrators, waive and release any and all rights and claims for damages that I may have against the race director and the towns of Bennington, North Bennington, Village School of North Bennington, Southern Vermont College, and the Bennington County Child Advocacy Center, their officers or members, their agents, representatives or assigns, for any and all injuries suffered by me before, during or after the Just Bike! justice for kids Ride. No headphones are allowed on the course and bike helmets are required. By signing below, I agree to these conditions.


Signature ___________________________________________________ Date _______________

Signature of parent (if entrant under 18) ____________________________Date _______________


Children 13 and younger must have a registered adult rider with them.

Adult Name: ______________________




T-Shirt Size (Guaranteed for first 125 Riders registered) No size guarantee for those registering after September 15.

  • Youth Medium
  • Youth Large
  • Adult Small
  • Adult Medium
  • Adult Large
  • Adult XL
  • Adult XXL (Additional $2.00)


Event After September 15

  • 20-Mile Green Mountain Boys Tour Individual $35.00 $40.00
  • 20-Mile Green Mountain Boys Tour Team $25.00 $30.00
  • 11-Mile Monument Loop Individual $35.00 $40.00
  • 11-Mile Monument Loop Team $25.00 $30.00
  • 5-Mile Covered Bridges 14 and older $35.00 $40.00
  • 5-Mile Covered Bridges 13 and under $15.00 $20.00
  • Family Ride 2 or 5 Mile $75.00 $80.00 (4-10 family members from same household)



Make Check out to BCCAC

Event Fee: ________________

XXL T-Shirt: ________________

Total: ____________________

Mail Registration Form and Check to:

Bennington County Child Advocacy Center (or BCCAC)

129 Elm Street

Bennington, VT 05201