Release and Waiver of Liability,
Assumption of Risk,
Indemnity, and Parental Consent Agreement
League of American Wheelman D/B/A League of American Bicyclists (LAB)
IN CONSIDERATION of being permitted to participate in any way in the
Mid-Valley Bicycle Club (Club) sponsored Covered Bridge Bicycle Tour
Bicycling Activities (Activity), I, for myself, my personal representatives,
assigns, heirs, and our next of kin:
1.
ACKNOWLEDGE, agree, and represent that I understand the nature of this
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.
2.
FULLY UNDERSTAND 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 conditions
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 may incur as
a result of my participation in the Activity.
3.
HEREBY RELEASE, DISCHARGE, AND
COVENANT NOT TO SUE the Club, the LAB,
its respective administrators, directors, agents, officers,
members, 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 a 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
any may incur as a result of such claim.
I AM 18 YEARS OF AGE
OR OLDER, HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT, UNDERSTAND
THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT, HAVE
SIGNED IT VOLUNTARILY 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 BY LAW.
I AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID,
THE BALANCE, NOT WITHSTANDING, SHALL CONTINUE IN FORCE AND EFFECT.
PARTICIPANT
NAME:______________________________________________________________
(Printed)
Date
PARTICIPANT
SIGNATURE: ____________________________________________
(18 or over)
Minor Release
(complete for Participants Under the Age
of 18)
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, IN GOOD HEALTH, AND IN
PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HERBY 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 ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.
MINOR'S NAME (PRINTED):___________________________________________________
BIRTH DATE OF MINOR: __________-___________-_________
Date
S IGNATURE OF MINOR PARTICIPANT:
______________________________________________________________________________________________________
PARENT/GUARDIAN NAME (PRINTED):
_______________________________________________________________________________________________________
PARENT/GUARDIAN SIGNATURE (only if participant is
under the age of 18):
_____________________________________________________________________
ADDRESS:
_________________________________________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
: (_______) _____________________________________________
DATE: _______________________________________________________
Fill out form and print and sign it
make checks payable to:
Mid-Valley Bicycle Club
mail to:
Covered Bridge Bicycle Tour
Box 1373
Corvallis, OR 97339-1373
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