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Woodcreek High School Mountain Bike Club – Ride Waiver Form
NAME: __________________________________________________ MAILING ADDRESS:__________________________________________________________________________________________ CITY: ______________________________ STATE: _____________________________ ZIP: _________________________________ HOME PHONE ____________________ EMAIL___________________________ EMERGENCY CONTACT________________________ EMERGENCY PHONE_____________________________
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY, AND PARENTAL CONSENT AGREEMENT In consideration of being permitted to participate in any way in Woodcreek High School cycling activities, I, for myself, representatives, assigns, heirs, and next of kin: Acknowledge, agree, and represent that I understand the nature of bicycling activities and that I am qualified, in good health, and in proper physical condition to participate in such activity. I further acknowledge that the activity will be conducted over public roads and facilities open to the public during the activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the activity. Fully understanding that: (a) bicycling activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis, and death (“risks”); (b) these risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the activity, the condition in which the activity takes place, or the negligence of the “releasees’” named below; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs and damages I incur as a result of my participation in the activity. Hereby release, discharge, and covenant not to sue Woodcreek High School, Chris LaFazia, Jim Winne, other parent coaches and helpers, and their respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the activity takes place, (each considered one of the “releasees” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I or anyone on my behalf, makes claim against any of the “releasees”, I will indemnify, save, and hold harmless each of the releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim. I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed, and agree that if any portion of this agreement is held to be invalid the balance notwithstanding, shall continue in full force and effect.
Printed Name of Participant:____________________________________________________________ And I, the minor’s parent and/or legal guardian, understand the nature of bicycling activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releasees from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise including negligent rescue operations and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the releasees named above, I will indemnify, save, and hold harmless each of the releasees from any litigation expenses, attorney fees, loss liability, damage, or cost as may occur as the result of any such claim.
Printed Name of Participant:____________________________________________________________ Address:______________________________________________________________________________________________________ Phone: ______________________________________
Parent/Guardian Signature:_____________________________________________________________
Date:________________________________________ |