Pilot Waiver & Acknowledgement
CWA-Mississauga Trishaw Pilot liability and confidentiality agreement
Pilot Agreement
I have received, read and understand the Cycling Without Age - Mississauga Pilot Handbook and Confidentiality guidelines, and agree to abide by the procedures listed therein and I attest that all of the information I have provided herein is accurate and complete. I understand and agree that acceptance into the program is entirely at the discretion of the Cycling Without Age - Mississauga program coordinator.
Pilot Waiver
I the undersigned, am the pilot named herein taking part in the Cycling Without Age - Mississauga Program as a trained trishaw pilot. I understand and agree that there are inherent risks associated with participation in this activity, that my participation is voluntary and that I am physically fit enough to participate in the activity. I accept all responsibility for my participation including the possibility of personal injury, death, property damage of any kind notwithstanding that the injury, loss may have been contributed to or occasioned by the negligence of the Cycling Without Age - Mississauga,and its officers, directors, employees, members, agents, assigns, legal representative and successors. I do hereby indemnify and hold harmless the Cycling Without Age - Mississauga, its officers, directors, employees, members, agents, assigns, legal representatives and successors and any and all business associates and partners involved in the above noted activity and each of them, their owners, officers and employees hereby waiving all claims for damage now or in the future arising from any loss, accident, injury or death which may be caused by or arise from participation of the individual named herein during this event; and agree to assume all risks for the activity noted above that the individual named herein has agreed to participate in. My signature acknowledges that I am over the age of 18 and had sufficient time to read and understand this waiver. I have had the opportunity to seek my own legal advice and that I understand and agree to the conditions stated in this document and that they are binding on my heirs, next of kin, executors, administrators and successors.
Pilot Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Acknowledged and witnessed by the undersigned on
Date
*
-
Month
-
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Pilot's Signature
*
Witness Signature
*
Witness' Full Name
*
First Name
Last Name
Witness' Phone Number
*
Please enter a valid phone number.
Please upload your Peel Regional Police Clearance certificate https://rec-check.peelpolice.ca/
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload your COVID vaccination certificate https://www.ontario.ca/page/proof-covid-19-vaccination
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Continue
Continue
Should be Empty: