West County Revolution Bike Shop
Rental Waiver and Release Form
PLEASE READ THIS INFORMATION CAREFULLY– A SIGNATURE IS REQUIRED
I freely acknowledge and realize the danger of participating in a West County Revolution, Inc, (herein referred to as WCR) bicycle tour or bicycle rental and I fully assume all risks including, but not limited to, collision with pedestrians, vehicles, other bicycle riders, and/or fixed or moving objects; the negligence of other bicycle riders, pedestrians, and drivers; and the dangers arising from falls and all types of travel/road surfaces; as well as the possibility of physical and/or mental trauma (or injury).
I hereby release, indemnify and agree to hold harmless WCR, its officers, directors,representatives, employees, agents, partners and participants from any and all losses, costs, damages, claims, demands, rights and causes of action of whatever kind or nature, including reasonable attorney fees, and including any and all negligence claims or causes of action, which may arise and which result from illness, personal injuries, property damage, death or any other damages or injuries, not included herein, occurring during, or as a result of, my participation in the WCR tour and or rental.
I also consent to and permit emergency medical treatment in the event of injury or illness. I understand and accept that any medical cost incurred with respect to emergency medical treatment will be my responsibility.
I realize that the WCR tour and or rental requires physical exertion and I represent that I am in sound medical condition capable of participating in the ride without risk to others or myself. I have no physical or medical impediment, which would endanger others or myself. I understand that the law defines a bicycle as a moving vehicle and I agree to follow all traffic laws, signs, rules, and regulations. I agree that I will, at all times during my participation in the WCR tour and or rental, adhere to all safety rules and regulations of WCR. I, as a responsible adult, will not use my cellular phone (to phone, to text, or to use other features that will take my eyes off the road) while riding on the tour and/or rental, due to the disruption it may cause to my concentration and the enjoyment of others on the tour. I, as a parent or guardian, take responsibility for my child’s actions and safety for the duration of the trip.
I am of legal age and fully competent, have read this Waiver and Release and fully understand it. If not of legal age, my parent or legal guardian has fully read the above Waiver and Release and understands it and that I am fully bound by their signature.I am responsible for the equipment and the way I ride. In the event of damage incurred during my ride, I am responsible for the repair costs. I take responsibility for any theft, loss or damage that might occur for the duration of the rental. In the event of theft or loss, I am responsible for the replacement value of the bike.
I was offered to use a free helmet with this bike rental. Please Initial: __________
I was offered to use a free lock with this bike rental. Please Initial: ____________
Printed name: __________________________
Signed: ________________________________ Date: ________________ |
Ċ ď West County Revolution, Oct 30, 2011 10:10 AM
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