Registration and Waiver

As part of the Hunterdon County Safe Routes Program, trained goHunterdon staff conduct bicycle safety activities, like skills drills, often called "bicycle rodeos" and/or group rides. These activities provide young riders with information and guidance to enhance riding skills, increase safety, and boost riding confidence. As part of these activities, goHunterdon will conduct helmet fittings and "bicycle readiness" assessments. Helmets and minimal bike repairs may be provided, at no charge, to ensure safe participation in the activity.

Child's Name*

First NameLast Name

Event Date*

Date

Event or School Name*

Grade Level*

Emergency Contact Name*

First NameLast Name

Relationship to Participant*

Emergency Contact Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

My child will bring their own helmet.My child does not have a helmet and requests to have one provided.

BicycleScooter

YesNo

Hand BrakesCoaster Brakes

New rider; little riding experienceSome riding experience; could use more practiceConfident rider

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

Acknowledge, agree, and represent that I understand the nature of the activity and that my child and/or I am qualified and in good health and proper physical condition to participate in such activity. I further acknowledge that the activity will be conducted according to generally accepted practices by goHunterdon, and I further agree and warrant that at any time I believe conditions to be unsafe, I will immediately discontinue my, or my child’s, further participation.I agree and represent that I, and/or my child, if participating, will utilize or wear the appropriate equipment for the activity, including a well maintained and properly fitted bicycle and bicycle helmet for bicycle activities, hi-visibility vest for bicycle or pedestrian activities, as provided by goHunterdon, or other safety equipment as provided by goHunterdon.Fully understand that: (a) such activity can involve some risk and danger; (b) these risks and dangers can be caused by my child’s 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 releases 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 or my child’s participation in the activity.Hereby release, discharge, and covenant not to sue goHunterdon and their respective directors, agents, officers, members, employees, and volunteers from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or part by the negligence of the releases or otherwise, including negligent rescue operations. I further agree that, despite this release and waiver of liability, assumption of risk, and indemnity agreement, if I or anyone on my behalf makes a claim against the releases, I will indemnify, save, and hold harmless each of the releases from any litigation, expenses, attorney fees, loss, liability, damage, or cost that may incur as the result of such a claim.

I hereby grant full permission to goHunterdon to use photographs, videotapes, or any other record of this event including name, likeness, and voice for any legitimate purpose.

I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and without inducement or assurance of any nature. I intend it 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 agreement is to be held invalid, that balance, not withstanding, shall continue in full force and effect.

Parent/Guardian’s Name*

First NameLast Name

Parent/Guardian’s Email*

example@example.com

Parent/Guardian’s Signature*

Please use mouse or finger to sign in the box above.

Registration & Waiver