Waiver And Disclaimer And Authorization/consent Form (Page 2 of 2) in pdf

MOTORCYCLE SAFETY CENTER OF VIRGINIA, INC.

Waiver & Release of Liability – Continued page 2 of 2

General Disclaimer

The Department of Motor Vehicles Virginia Rider Training Program coaches the basic fundamental motorcycle

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skills necessary to begin riding a motorcycle and is NOT intended to produce the advanced riding skills of an

experienced rider. Students who fail to demonstrate the acquisition of the basic skills necessary for

everyone’s safety during the course will be required to withdraw from the class. In this instance, refunds,

transfers and/or credits will not be provided.

You are expected to attend the entire training session to which you are assigned to include arriving and returning

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from breaks on time. If you are not present at your assigned start time, either in the classroom or on the range,

you will be dropped from the class. If for any reason, including injury, illness, late arrival or personal/family

issues, you are unable to complete the class in which you enrolled, you will not be entitled to receive a

refund of your tuition payment. If you choose to re-enroll in another class, you will be required to attend

the full curriculum and pay the full tuition and registration fees again.

MSCV does not guarantee your successful completion of the training or your safety during the course.

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Successful completion of the Motorcycle Course is not a guarantee that you will be safe on the road.

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INJURY OR DEATH CAN OCCUR WHEN OPERATING A MOTORCYCLE! You and you alone are responsible for

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your safety. Good balance & motor skills are a few basic skills needed to take this course.

You are required by law to wear protective gear on the range to include:

A minimum three-quarter shell motorcycle helmet that meets U.S. Department of Transportation Safety

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standards.

Full-fingered gloves made of leather or other material resistant to abrasion.

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Long pants of denim or material of other equivalent or better durability free of holes, and a long-sleeved shirt

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or jacket for protection.

Shoes/Boots - Over the ankle with little to no heel. Shoes can be an athletic or a hiking shoe that provides

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reinforced ankle support. Boots are preferred. Your footwear should have a good rubber sole for traction and

the heel shouldn't be higher than what is commonly on a "workman's boot". Thin fabric shoes made of canvas

or other fabrics that do not provide support are not acceptable. The classic Converse All Star "Chuck Taylor" or

dress shoe are examples of shoes that DO NOT meet the requirements.

Eye Protection (sunglasses, prescription glasses, safety glasses or goggles).

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Failure to arrive on the range with the required protective gear will result in your dismissal from the course.

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Refunds, transfers and/or credits will not be provided if you fail to bring proper protective riding gear as

described above.

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING THIS FORM, I AGREE IT IS MY INTENTION

TO EXEMPT AND RELIEVE DMV & MSCV FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR

WRONGFUL DEATH CAUSED BY MY NEGLIGENCE, MSCV, Inc. OR OTHER CAUSES.

By signing below, you knowingly and willingly give permission(s) and agree to all sections of pages 1 and 2 of this

form. You also acknowledge you understand participating in this class is dangerous and injury or death can occur and

you accept responsibility for your actions and omissions.

✔

____________________________________________________ Student’s Date of Birth: MM/_______/ DD_______/ YYYY___________

PRINT NAME OF STUDENT

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____________________________________________________ Today’s Date: MM/_______/ DD_______/ YYYY___________

SIGNATURE OF STUDENT

_______________________________________________________ MM/_______/ DD_______/ YYYY___________

*PRINT NAME OF PARENT OR GUARDIAN

*DATE SIGNED BY PARENT OR GUARDIAN

IF STUDENT IS UNDER 18 YEARS OF AGE – THIS FORM SHALL BE NOTORIZED OR SIGNED IN FRONT OF INSTRUCTOR BY PARENT OR GUARDIAN

_______________________________________________________ (___ ___ ___) ____ ____ ____-_____ _____ _____ ______

*SIGNATURE OF PARENT OR GUARDIAN CONTACT NUMBER OF PARENT OR GUARDIAN

Revised: December 31, 2016

Waiver And Disclaimer And Authorization/consent Form Page 2

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