Complete Release Of Liability Form printable pdf download

Complete Release of Liability

Name of Rider: _________________________________ Date/Time: _____________________________

NRIC/Passport No: ______________________________Contact No: _____________________________

Address: ______________________________________________________________________________

This Agreement, Waiver of Negligence and Complete Release of Liability cover the use of a Segway® Personal Transporter (“PT”) and

related equipments which has been provided by Gogreen Holdings Pte. Ltd. for a trial experience.

Use and Operation. I wish to use a PT for a trial experience. I confirm that I have no physical or medical condition that may

impair my riding of the PT. I also confirm that I am physically able to climb and descend stairs without the support of a handrail

or other walking aid and am able to step on and off the PT without assistance. I confirm that I am not pregnant. I acknowledge

having received instruction on the operation of the PT. I agree to use and operate the PT in a careful, considerate, and safe manner

with due consideration for the safety and well being of all persons. I understand that the helmet is provided for my safety and I

agree to wear the helmet and have it fastened at all times when operating the PT. I agree to cease operation of the PT if I am

concerned in any way about the operation or a malfunction or damage to the PT.

Assumption of Risk. I understand and acknowledge that improper operation of the PT has a potential for serious injury to

persons, including the operator, and for loss of or damage to property, including, but not limited to, the PT. I am fully aware that

the minimum recommended age of a rider of the PT is 18 and that the recommended weight of the rider is between 100 and 260

pounds (equivalent to 45 and 118 kilograms). I confirm that I accept full, sole and unconditional responsibility for my health and

safety as a result of my using and operating the PT including but not limited to the risk of personal injury. I am voluntarily

participating in this trial experience of the PT with the knowledge of the dangers involved and I agree to accept any and all risks of

loss, injury, or death. I also understand and acknowledge that PT’s are new and unique devices, that their operation in public

places attracts a great deal of attention from people wishing to observe the use of the device and to more closely inspect the

devices, and that such interest and desire to gain a closer inspection of the device can create situations in which the operation of the

device can be dangerous with regard to the operator and others.

Release of Claims and Indemnification. In consideration for being permitted to use the PT I agree to assume all risks and to

release and hold harmless Gogreen Holdings Pte. Ltd. and all its officers, directors, agents, employees, and members, from and

against any and all causes of actions, claims or other liabilities of any nature whatsoever and howsoever arising which may result

from my participation in the Segway® Fun Ride /Guided Eco Adventure and using the PT. I intend by this Waiver and Release to

release, in advance, and to waive my rights and discharge all of the persons mentioned above from any and all claims whatsoever

and howsoever arising including but not limited to negligence for damages or property damage which I have or which may

thereafter accrue to me, as a result of my use of the PT. I understand and agree that this Waiver and Release is binding on my

heirs, assigns, and legal representatives. I agree to indemnify and hold Gogreen Holdings Pte. Ltd. harmless from and against any

and all claims, demands, causes of action, suits, judgments, decrees, liabilities, obligations, losses, damages, costs and expenses,

including legal fees, costs and expenses incurred by Gogreen Holdings Pte. Ltd. with regards to such matters, for injuries of any

type or kind, including death, to any person and for loss of or damage to property of any type or kind, including the property rented

to me under this Agreement, arising out of my negligence and or related to or in connection with my use and operation of the PT

and the other property rented to me pursuant to this Agreement and for my failure to fully and completely comply with the terms,

provisions and conditions of this Agreement.

Consent to Medical Treatment. I hereby consent to receive medical treatment which may be deemed advisable in the event of

injury, accident and/or illness while riding the PT.

Governing Law. This Agreement shall be governed by and construed under the laws of Singapore.

I have carefully read this Waiver and Release and fully understand its contents. I certify that I am at least 18 years of age. I am aware

that this is a RELEASE OF LIABILTY and a contract between me and the persons and entities mentioned above and all of their

respective officers, directors, employees, agents and representatives, and I sign it of my own free will.

THIS IS AN IMPORTANT LEGAL DOCUMENT. READ IT CAREFULLY BEFORE SIGNING BELOW.

Signature of Rider: ________________________________

Complete Release Of Liability Form

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