Waiver & Release Of Liability - Motorcycle Safety Center Of Virginia, Inc., Virginia Department Of Motor Vehicles (Dmv) Page 2

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

 

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

  G eneral   D isclaimer  

 

The   D epartment   o f   M otor   V ehicles   V irginia   R ider   T

raining  

P rogram   c oaches   t he   b asic   f undamental  

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motorcycle   s kills   n ecessary   t o   b egin   r iding   a   m otorcycle   a nd   i s   N OT   i ntended   t o   p roduce   t he   a dvanced  

riding   s kills   o f   a n   e xperienced   r ider.     S tudents   w ho   f ail   t o   d emonstrate   t he   a cquisition   o f   t he   b asic   s kills  

necessary   f or   e veryone’s   s afety   d uring   t he   c ourse   w ill   b e   r equired   t o   w ithdraw   f rom   t he   c lass.     I n   t his  

instance,   r efunds,   t ransfers   a nd/or   c redits   w ill   n ot   b e   p rovided.  

 

You   a re   e xpected   t o   a ttend   t he   e ntire   t raining   s ession   t o   w hich   y ou   a re   a ssigned   t o   i nclude   a rriving   a nd  

•

returning   f rom   b reaks   o n   t ime.     I f   y ou   a re   n ot   p resent   a t   y our   a ssigned   s tart   t ime,   e ither   i n   t he  

classroom   o r   o n   t he   r ange,   y ou   w ill   b e   d ropped   f rom   t he   c lass.     I f   f or   a ny   r eason,   i ncluding   i njury,   i llness,  

late   a rrival   o r   p ersonal/family   i ssues,   y ou   a re   u nable   t o   c omplete   t he   c lass   i n   w hich   y ou   e nrolled,   y ou  

will   n ot   b e   e ntitled   t o   r eceive   a   r efund   o f   y our   t uition   p ayment.     I f   y ou   c hose   t o   r e-­‐enroll   i n   a nother   c lass,  

you   w ill   b e   r equired   t o   a ttend   t he   f ull   c urriculum   a nd   p ay   t he   f ull   t uition   a nd   r egistration   f ees   a gain.  

 

MSCV   a nd   R IM   d oes   n ot   g uarantee   y our   s uccessful   c ompletion   o f   t he   t raining   o r   y our   s afety   d uring   s uch.      

•

 

Successful   c ompletion   o f   t he   M otorcycle   C ourse   i s   n ot   a   g uarantee   t hat   y ou   w ill   b e   s afe   o n   t he   r oad.  

•

 

You   a re   r equired   b y   l aw   t o   w ear   p rotective   g ear   o n   t he   r ange   t o   i nclude   a   ¾   o r   f ull-­‐face   h elmet,   f ull-­‐fingered  

gloves   m ade   o f   l eather   o r   o ther   m aterial   r esistant   t o   a brasion,   l ong   p ants   o f   d enim   o r   m aterial   o f   o ther  

equivalent   o r   b etter   d urability   f ree   o f   h oles,  

L ong-­‐sleeved   s hirt   o r   j acket   f or   p rotection   i n   t he   e vent   o f   a   f all  

or   c

rash   a nd   s turdy   o ver-­‐the-­‐ankle   b oots   t o   p rotect   t he   a nkles   a nd   f eet   w ith   l ittle   o r   n o   h eel   a nd   n o   c loth   o r  

canvas   a nd   E ye   P rotection   ( sunglasses,   p rescription   g lasses,   s afety   g lasses   o r   g oggles).   F ailure   t o   a rrive   o n  

the   r ange   w ith   t he   n ecessary   p rotective   g ear   w ill   r esult   i n   m y   d ismissal   f rom   t he   c ourse.     R efunds,   t ransfers  

and/or   c redits   w ill   n ot   b e   p rovided.  

 

I   H AVE   R EAD   T HE   A BOVE   W AIVER   A ND   R ELEASE   A ND   B Y   S IGNING   I T   A GREE   I T   I S   M Y   I NTENTION   T O  

EXEMPT   A ND   R ELIEVE   D MV   &   M SCV   F ROM   L IABILITY   F OR   P ERSONAL   I NJURY,   P ROPERTY   D AMAGE   O R  

WRONGFUL   D EATH   C AUSED   B Y   M Y   N EGLIGENCE,   M SCV,   I nc.,   R IM   O R   O THER   C AUSE.  

INJURY   O R   D EATH   C AN   O CCUR   W HEN   O PERATING   A   M OTORCYCLE!   Y ou   a nd   y ou   a lone   a re   r esponsible  

for   y our   s afety.   G ood   b alance   &   m otor   s kills   a re   a   f ew   s kills   n eeded   t o   t ake   t his   c ourse.  

 

By   s igning   b elow,   y ou   k nowingly   a nd   w illingly   g ive   p ermission(s)   a nd   a gree   t o   a ll   s ections   o f   p ages   1  

and   2   o f   t his   f orm.    

You   a lso   a cknowledge   y ou   u nderstand   p articipating   i n   t his   c lass   i s   d angerous,   i njury   o r   d eath   c an  

occur   a nd   y ou   a ccept   r esponsibility   f or   y our   a ctions   a nd   o missions.  

 

 

 

 

 

 

 

 

 

MM/_______/   D D_______/   Y YYY___________  

PRINT   N AME   O F   R IDER/STUDENT  

 

 

 

DATE   O F   B IRTH  

 

 

 

 

 

 

 

 

 

 

MM/_______/   D D_______/   Y YYY___________  

SIGNATURE   O F   R IDER/STUDENT  

 

 

 

DATE   S IGNED    

 

 

 

 

 

 

 

 

 

 

MM/_______/   D D_______/   Y YYY___________  

*PRINT   N AME   O F   P ARENT   O R   G UARDIAN  

 

 

*DATE   S IGNED   B Y   P ARENT   O R   G UARDIAN  

(If   r ider/student   i s   l ess   t han   1 8   y ears   o f   a ge)  

 

 

 

 

 

 

 

 

                            C ONTACT   N UMBER   O F   P ARENT   O R   G UARDIAN  

*SIGNATURE   O F   P ARENT   O R   G UARDIAN                                                                                      

 

 

 

 

 

Revised   S eptember   1 0,   2 013