Member Registration And Photograph And Video Release Forms

PEDAL Registration Information & Release Form

New

Renewal

IN CONSIDERATION of being permitted to participate in any way in PEDAL-Sponsored Bicycling Activities ("Activities" or "Rides") I for myself,

my personal representatives, assigns, heirs, and next of kin:

ACKNOWLEDGE, agree, and represent that I understand the nature of Bicycling Activities and that I am qualified 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;

FULLY UNDERSTAND that: (a) bicycling activities involve risk 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 in the Activity;

While PEDAL works to promote safe cycling, it can take no responsibility for the safety of any individual. Riding a bicycle on public

roadways is as hazardous as driving an automobile on those same roadways. Off-road cycling holds its own unique hazards in addition to

many of those present in cycling on public roadways. When PEDAL publishes a route for one of its bicycle Rides, it assumes no

responsibility for your safety

PEDAL will not knowingly lead cyclists into unsafe conditions outside those a reasonable person would expect to encounter given the

specified destination. PEDAL will do its best to advise cyclists of safe riding technique. PEDAL cannot, however, guarantee safety, since

we can't control your actions or the actions of others, including by not limited to motorists. Other hazards may exist, since PEDAL has

imperfect knowledge of the condition of the roadway and PEDAL has no control concerning hazards which may exist

PEDAL Rides are social Rides and are not the same as some major organized rides. PEDAL Rides are not over closed roads. These Rides

are over open roads with other vehicular traffic and involve the attendant risks of traffic. PEDAL Rides do not incur police escorts or any

other special safety features. Riders must understand they are riding in traffic and each rider assumes the same risk as if he or she were

riding alone along the same route

BY COMPLETING AND SUBMITTING THIS FORM, I AFFIRM THAT I HAVE READ THIS AGREEMENT AND THAT I 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 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 AGREEMENTIS HELD

TO BE INVALID, THE BALANCE NOT WITHSTANDING SHALL CONTINUE IN FULL FORCE AND EFFECT

If family membership, each member must complete and submit a separate form; if under age 18, parent/guardian must submit this form.

Name (Printed): _______________________________________________________________________________________

Address: ______________________________________ City: _________________ State: _______ Zip Code: ________

E-Mail Address: _____________________________________________________ Phone: __________________________

Emergency Contact Name: ______________________________________________ Phone: __________________________

Signature: __________________________________________________________________ Date: ____________________

I have read and agree to the terms above

Minor Release (To be filled in only if participant is 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 hereby 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: _____________

Guardian/Parent Signature: ______________________________________________________ Date: __________________

I have read and agree to the terms above

Address: ________________________________________City: _________________ State: _______ Zip Code: _______

E-Mail Address: ________________________________________________________ Phone: _______________________

Please read and complete the second page of this release.

Member Registration And Photograph And Video Release Forms - Pedal Club

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