Release Of Liability Waiver

Your Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

Cell Phone Number*

Email*

example@example.com

Date of Birth*

Date

In consideration of being allowed to participate in any way in this sports activity, related events, and activities, the undersigned appreciates and acknowledges:

1) I understand the risk of injury or illness from the activities involved in this sport is significant, including the potential for permanent paralysis and death; and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury or illness does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM ALL NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation; and,

2) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such hazard to the attention of the nearest official immediately; and,

3) I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE AND HOLD HARMLESS WESTERN CYCLE & SPORTING GOODS CO LTD, Western Cycle Rides; and the event host/sponsor/organization or club named herein; their officers & directors, officials, agents, and/or employees, ride leaders, and store ambassadors, other participants, sponsoring agencies, commissions, sponsors, advertisers, volunteers, coaches, steerers, and, if applicable, owners and lessors of premises used to conduct club activities/ special event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

4) I also acknowledge that photographs and video may be taken of me in my participation in, and attendance at this event or club activity, and hereby freely agree to allow without restriction all uses of such photos and videos in the reporting of club activities, special race, and/or in the promotion of such, its location, other sporting events, sport in general, and/or related purposes.

By signing below I acknowledge that I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY.

Signature*

Signed by*

First NameLast Name

Date*

Date

If under the age of 18 you must have a parent or legal guardian sign this waiver before you may participate in any activities with the club or in the event named herein.

Name of Parent/ Guardian

First NameLast Name

Phone Number

Area CodePhone Number

Relationship to Participant

Signature of Guardian

Signed by

First NameLast Name

Date

In Case of an Emergency Please contact:

Cell Phone Number

Area CodePhone Number

Relationship to Participant

Participant Release of Liability Waiver

RIDES