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If you are new to PWCC, you need to sign a waiver of liability.  When you come to your first ride, if you have not enrolled online, you may print a copy of this form, sign it, and give it to the ride leader. 

The form is also kept at the Apple Box.  

 

PETALUMA WHEELMEN CYCLING CLUB (“PWCC”)

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY

AND PARENTAL CONSENT AGREEMENT

(“AGREEMENT”)

 

In Consideration of being permitted to participate in any way in PWCC sponsored Bicycling Activities (“Activity”) I, for myself, my personal representatives, assigns, heirs, and next of kin:

1. 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.

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 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 or that of the minor in the Activity.

3. Hereby release, discharge, and covenant not to sue PWCC, their 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 indemnityagreement 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 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 by law 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:____________________________________________________

 

Phone:____________________________

 

Address:_________________________________________________________________________________________

                           (Street)                                                                    (City)                                     (State) (ZIP)

 

Participant’s signature (only if age 18 or over): ___________________________________________

 

I have read this release_____________(initials)    Date:_________________________

 

MINOR RELEASE

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 hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releasee’s 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.

 

Printed Name of  Parent/Guardian:_______________________________________________Phone:______________________

 

Address:_________________________________________________________________________________________

                            (Street)                                                                    (City)                                     (State) (ZIP)

 

Parent/Guardian Signature (only if participant is under the age of 18):

 

_______________________________________

 

I have read this release_____________(initials)    Date:_________________________

 

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