Endurance Ride Release and Waiver of Liability Form

Endurance Ride Release and Waiver of Liability Form
I, the undersigned, will be participating in a bicycle ride (hereafter the “activity”) with Calvary Chapel Chino Valley.

I recognize that there are risks involved in participating in this activity and hereby assume all risk of injury, harm, damage, or death in connection with my participation in this activity. I understand and agree that neither Calvary Chapel Chino Valley nor its trustees, officers, directors, employees, agents or representatives may be held liable in any way for any injury, harm, damage, or death that may occur to me as a result of my participation in this activity and hereby release Calvary Chapel Chino Valley its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death, which may occur while I am participating in the activity. To the fullest extent permitted by law, I agree to save and hold harmless Calvary Chapel Chino Valley its trustees, officers, directors, employees, agents and representatives from any claim by myself, my estate, heirs, successors, assigns or other persons arising out of my participation in the activity.

I authorize Calvary Chapel Chino Valley through its trustees, officers, directors, employees, agents or representatives to render or obtain such emergency medical care or treatment for me as may be necessary should any injury, harm or accident occur to me while participating in this activity.

I understand and acknowledge that Calvary Chapel Chino Valley does not provide health or medical insurance in connection with the activity and I agree that I will be financially responsible for any bills incurred as a result of medical treatment, including emergency medical treatment and/or transportation to a medical facility, in connection with my participation in the activity.
Signature*

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Today's Date*

MonthDayYear
Name*

First NameLast Name
Gender*

MaleFemale
Phone*
Email*

Confirmation Emailexample@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact
Name*

First NameLast Name
Relationship to you*
(i.e. Grandpa, Grandma, Uncle, Aunt, Family Friend, etc.)
Phone*
Medical Information
Do you have any medical restrictions or handicaps?*

YesNo
If yes, briefly explain:
Are you currently taking any medication?*

YesNo
Please list any prescribed medications and the reason they are taken:
FINAL AGREEMENT
My initials below indicate that I hereby agree to the terms written at the beginning of this release and waiver of liability form. My initials also signify that I have provided all truthful and pertinent information in relation to the care and well-being of myself.
Initials*
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Endurance Ride Release and Waiver of Liability Form

Emergency Contact

Medical Information

FINAL AGREEMENT