Waiver & Release Of Liability - Motorcycle Safety Center Of Virginia, Inc., Virginia Department Of Motor Vehicles (Dmv)

MOTORCYCLE   S AFETY   C ENTER   O F   V IRGINIA,   I NC.  

 

Waiver   &   R elease   o f   L iability   –   p age   1   o f   2  

 

READ   C AREFULLY  

 

In   c onsideration   o f   V irginia   D epartment   o f   M otor   V ehicles   ( DMV),   M otorcycle   S afety   C enter   o f  

Virginia,   I nc.   ( MSCV)   a nd   R ider’s   I n   M otion   ( RIM),   f urnishing   s ervices   a nd/or   e quipment   t o   e nable   m e   t o  

participate   i n   t he   M otorcycle   R ider   E ducation   c lass,   I   a gree   a s   f ollows:  

 

 

I fully understand, agree and acknowledge, that: (a) Risks and dangers exist in my use of motorcycles and

motorcycle equipment and my participation in the Motorcycle Rider Education Class activities; (b) My

participation in such activities and/or use of such equipment may result in injury or illness including, but not

limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could

cause serious disability; (c) These risks and dangers may be caused by the negligence of, myself, the owners,

employees, officers or agents of DMV, MSCV, RIM, the negligence of the participants, the negligence of others,

accidents, breaches of contract, the forces of nature or other causes. These risks and dangers may arise from

foreseeable or unforeseeable causes; and (d) By my participation in these activities and/or use of equipment, I

hereby assume all risks and dangers and all responsibility for any losses and/or damages, whether caused in whole

or in part by the negligence or other conduct of the owners, agents, officers, or employees of DMV, MSCV, RIM

or by any other person.

Initial________

I,   o n   b ehalf   o f   m yself,   m y   p ersonal   r epresentatives   a nd   m y   h eirs   h ereby   v oluntarily   a gree   t o   r elease,  

waive,   d ischarge,   h old   h armless,   d efend   a nd   i ndemnify   D MV,   M SCV,   R IM   a nd   i ts   o wners,   a gents,   o fficers   a nd  

employees   f rom   a ny   a nd   a ll   c laims,   s uits   o r   c auses   o f   a ction   f or   b odily   i njury,   p roperty   d amage,   w rongful  

death,   l oss   o f   s ervices   o r   o therwise   w hich   m ay   a rise   o ut   o f   m y   u se   o f   m otorcycles   a nd   m otorcycle  

equipment   o r   m y   p articipation   i n   t he   M otorcycle   R ider   E ducation   C lass   a ctivities.     I   s pecifically   u nderstand  

that   I   a m   r eleasing,   d ischarging   a nd   w aiving   a ny   c laims   o r   a ctions   t hat   I   m ay   h ave   p resently   o r   i n   t he   f uture  

for   t he   n egligent   a cts   o r   o ther   c onduct   b y   D MV,   M SCV,   R IM   a nd   i ts   o wners,   a gents,   o fficers   o r   e mployees.  

 

 

 

                                                                                                                                                                                                                                                                                                                                                    I nitial____________  

 

I   u nderstand,   i n   t he   e vent   o f   a n   a ccident,   i njury,   o r   i llness,   m edical   a ssessment   a nd   t reatment   m ay   b e  

necessary.     I n   t hese   i nstances,   M SCV,   R IM   a nd   i ts   o wners,   a gents,   o fficers,   e mployees   a nd/or   c ontractors   w ill  

recommend   9 11   b e   c ontacted   f or   t he   p urpose   o f   a ssessing,   t reating   a nd   r eferring   i ndividual’s   r equiring  

these   s ervices.   I   u nderstand   t hat   b asic   f irst   a id   t reatment   m ay   b e   n ecessary   a t   t he   t raining   s ite   o r   t hat  

advanced   t reatment   m easures   m ay   b e   r ecommended   b y   9 11-­‐dispatch.   I   u nderstand   a nd   a cknowledge   M SCV,  

RIM   a nd   i ts   o wners,   a gents,   o fficers,   e mployees   a nd   c ontractors   a re   n ot   l icensed   o r   t rained   p re-­‐hospital  

providers   a nd   a s   s uch,   d o   n ot   a ssume   r esponsibility   f or   t he   e valuation   o r   t reatment   o f   i njuries.   I ndividuals  

sustaining   m inor   i njuries   l imited   t o   s uperficial   a brasions,   c uts   o r   b ruises   m ay   u tilize   b asic   f irst   a id  

equipment/supplies   a vailable   a t   e ach   t raining   s ite.     I ndividuals   r efusing   b asic   f irst   a id   o r   9 11   n otification  

will   b e   p rovided   w ith   a   r efusal   f orm   t o   s ign   a cknowledging   t hese   s ervices   w ere   o ffered   a nd   d eclined   b y   t he  

involved   i ndividual.      

                                                                                                                                                                                                                                                                                                                  I nitial___________  

 

Students   u nder   t he   a ge   o f   1 8:     A s   t he   p arent   o r   l egal   g uardian   o f   a   m inor   u nder   t he   a ge   o f   1 8,   I  

understand,   a cknowledge   a nd   p rovide   m y   p ermission   f or   M SCV,   R IM   a nd   i ts   o wners,   a gents,   o fficers,  

employees   a nd/or   c ontractors   t o   i nitiate   b asic   f irst   a id   t reatment   a nd/or   c ontact   9 11   d ispatch   i n   m y  

absence   f rom   t he   t raining   s ite.     F urthermore,   I   u nderstand,   i n   t he   e vent   t he   m inor   s tudent   r efuses   9 11  

notification   o r   t ransport,   h e/she   w ill   b e   p rovided   w ith   a   r efusal   f orm   t o   s ign   d ocumenting   s uch.     K nowing  

this,   I   p rovide   t he   m inor   s tudent   w ith   m y   p ermission   a s   h is/her   p arent   o r   l egal   g uardian   t o   p rovide  

permission   o r   r efusal   f or   b asic   f irst   a id   a nd/or   9 11-­‐dispatch   n otification.                          

                                                                                                                                                                                                                                                                        I nitial___________  

 

 

Revised   S eptember   1 0,   2 013