Full Legal Name
*
Full Legal Name
Nom de famille
Email
*
exemple@exemple.com
Date of Birth:
/
Month
/
Day
Year
Date of Birth:
Phone:
*
Phone:
Format: (000) 000-0000.
Emergency Contact — Name
*
Emergency Contact — Name
Emergency Contact — Phone
Emergency Contact — Phone
Format: (000) 000-0000.
MEDIA & IMAGE RIGHTS
I AGREE to the media release above
I DO NOT AGREE to the media release
GOVERNING LAW & JURISDICTION
Florida
Utah
Colorado
PARTICIPANT DECLARATIONS
*
I am 18 years of age or older and I have valid proof of age available upon request.
I understand that I am waiving significant legal rights by signing this document.
I have read this entire Agreement carefully and understand its contents.
I confirm I am in good physical health and able to participate in the SKwheel demonstration.
I voluntarily choose to participate in the SKwheel demonstration knowing the risks involved.
I understand SKwheel is a fully manufactured electric ski product developed and produced by E-LINE SAS.
I agree to follow all safety instructions given by SKwheel staff before and during the demonstration.
I have had the opportunity to ask questions and all my questions have been answered satisfactorily.
Date
*
/
Mois
/
Jour
Année
Date
SKwheel Waiver CO UT FL
Soumettre
Adresse
Address:
Street Address Line 2
City / State / ZIP:
Département/Région
Code postal
Participant Signature
*
Testing location
*
Cyrusher E-Bike
Should be Empty: