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FREERIDE BICYCLE CLUB RELE-2

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					  FREERIDE BICYCLE CLUB RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF
   RISK, AND INDEMNITYAND PARENTAL CONSENT AGREEMENT ("AGREEMENT")


IN CONSIDERATION of being permitted to participate in any way in FREERIDE Bicycle Club sponsored Bicycling Activities ("Activity"), I
for myself, my personal representatives, assigns, heirs, and next of kin:

1. ACKNOWLEDGE AND UNDERSTAND that riding a bicycle involves the inherent RISK OF DEATH, SERIOUS INJURY AND
PROPERTY LOSS and the consequences of such, which includes loss of income, medical bills and emotional suffering to myself
and others. I also understand that such risks are inherent to bicycle riding, which include but not limited to personal, loaned or
borrowed bicycle equipment, roads, traffic, weather and other conditions which may affect safe riding and also risks which are also
caused by my negligence and negligence of other people (including negligent rescue) who may be riding bicycles with me or who
may participate in any bicycle event or activity in which I might ride.
2. I HEREBY ACKNOWLEDGE AND ASSUME ALL RISK OF MY DEATH, INJURY AND PROPERTY LOSS WHICH MIGHT
RESULT FROM MY PARTICIPATION IN ANY AND ALL BICYCLING ACTIVITY SPONSORED, CONTROLLED AND OR
ORGANIZED BY THE FREERIDE BICYCLE CLUB AND OR ITS MEMBERS, OFFICERS, VOLUNTEERS, EMPLOYEES,
PARTICIPANTS, SPONSORS, ADVERTISERS, AND IF APPLICABLE, OWNERS AND LESSORS OF PREMISES ON WHICH
THE ACTIVITY TAKES PLACE, AND ALL OTHERS INVOLVED. I also understand that when I ride a bicycle, I may suffer death,
serious injury and property loss by reason of the negligence of members, officers, sponsors and volunteers of the FREERIDE
Bicycle Club who may be riding bicycles with me or who may participate in any bicycle event sponsored, controlled, and or
organized by the FREERIDE Bicycle Club in which I might ride or participate. I understand that such losses may result from
negligent rescue by members, officers, sponsors and volunteers of the FREERIDE Bicycle Club. I acknowledge and agree that
FREERIDE Bicycle Club and or its members, officers, sponsors and volunteers owe no duty to rescue me if I am injured while
participating in any bicycle event sponsored, controlled, and or organized by the FREERIDE Bicycle Club.
3. I EXPRESSLY WAIVE ANY AND ALL CLAIMS, CAUSES OF ACTIONS against the FREERIDE Bicycle Club, its members,
officers, sponsors, volunteers and all other parties involved which I might accrue by reason of any negligence (including negligent
rescue) of any member, officer, sponsor or volunteer of FREERIDE Bicycle Club in any bicycle event sponsored, controlled, and or
organized by the FREERIDE Bicycle Club.
4. I EXPRESSLY WAIVE, DISCHARGE, AND RELEASE from any and all liability for my death, injury and or loss of any kind or
character which might accrue to me by reason any negligence of any member, officer, sponsor or volunteer of the FREERIDE
Bicycle Club in any bicycle event sponsored, controlled, and or organized by the FREERIDE Bicycle Club. Although no member,
officer, sponsor or volunteer of the FREERIDE Bicycle Club, owes any duty to rescue me in event I suffer an injury or loss while
riding a bicycle, this waiver also applies to any injury, death or loss which I might suffer by reason of negligent rescue by any
member, officer, sponsor or volunteer of the FREERIDE Bicycle Club in any bicycle event sponsored, controlled, and or organized
by the FREERIDE Bicycle Club.
5. I EXPRESSLY AGREE TO INDEMNIFY, DEFEND (including the payment of attorney fees), SAVE HARMLESS the FREERIDE
Bicycle Club and any and all of its members, officers, sponsors and volunteers from ANY AND ALL CLAIMS, CAUSES OF ACTION
which I might accrue by reason of any negligence of any member, officer, sponsor or volunteer of the FREERIDE Bicycle Club, in
any bicycle event sponsored, controlled, and or organized by the FREERIDE Bicycle Club. Although no member, officer, sponsor or
volunteer of the FREERIDE Bicycle Club owes any duty to rescue me in event I suffer an injury or loss while riding a bicycle, this
indemnification agreement also applies to any injury, death or loss which I might suffer by reason of negligent rescue by any
member, officer, sponsor or volunteer of the FREERIDE Bicycle Club in any event sponsored, controlled, and or organized by the
FREERIDE Bicycle Club.
6. I EXPRESSLY AGREE TO INDEMNIFY, DEFEND, SAVE HARMLESS the FREERIDE Bicycle Club and any and all its members,
officers, sponsors or volunteers from ANY AND ALL CLAIMS, CAUSED OF ACTIONS which others might accrue by reason of my
negligence in any bicycle event sponsored, controlled, and or organized by the FREERIDE Bicycle Club including negligent rescue,
unless I am a member, officer or volunteer of the FREERIDE Bicycle Club.

This waiver, assumption of the risk and indemnification agreement (including all terms and conditions) is binding upon my
executor(s), heir(s), successor(s) in interest and assigns.


PRINTED NAME OF PARTICIPANT
____________________________________________________________________________________________________________________

ADDRESS:___________________________________________________________________________________________________________
                                   (Street)                  (City)                      (State)       (Zip)
PHONE: ______________________________

PARTICIPANT'S SIGNATURE (required if 18 or older): ________________________________________________ DATE: _____________


                PARENT GUARDIAN WAIVER FOR MINORS (Required if Participant is less than 18 years old)

The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity
and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim
or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and
release said parties on behalf of the minor and the parents or legal guardian.
PRINTED NAME OF PARENT/GUARDIAN: _____________________________________________________________________________

ADDRESS: __________________________________________________________________________________________________________
                                   (Street)                   (City)              (State)             (Zip)
PHONE: ______________________________

PARENT/GUARDIAN SIGNATURE __________________________________________________________DATE:____________________
                                    FREERIDE BICYCLE CLUB EMERGENCY
                                        MEDICAL/DENTAL FORM
                                    RELEASE AND CONSENT AGREEMENT
                                    1. The undersigned (hereinafter "Undersigned") does hereby authorize FREERIDE Bicycle Club, its staff,
members, volunteers and sponsors (hereinafter “Club”) to consent to IMMEDIATE FIRST AID MEDICAL CARE, any X-ray, examination,
anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care for the participant or member which is deemed advisable by and
to be rendered under the general or special supervision of any physician or surgeon, licensed under the provision of the Medicine Practice Act or
any dentist licensed under the Dental Practice Act, at any hospital, dental office, or elsewhere.
2. I understand that my insurance and/or my finances will cover any such treatment and that the Club will not be liable, whether or not I am
insured.
I understand that the participant or member will be taken to a hospital/medical facility by car or by ambulance if the Club believes that the
Participant may need medical/dental attention.
3. I understand that incidents, accidents, physical/medical and dental emergencies which occur on Club trips or activities outside the
Sacramento / Elk Grove area will be treated at a nearby hospital or medical facility whether or not my insurance applies at such a facility and I
assume total financial responsibility for payment of all such services.
4. It is understood that an effort will usually be made to contact the Undersigned prior to transporting or rendering treatment to the Participant, but
that any of the above transportation or treatment will not be withheld if for any reason the Undersigned is not contacted.
5. I the Undersigned do hereby authorize the Club to act as my agent in presenting this agreement to any qualified medical/dental practitioners
and will not hold the Club liable for any treatments rendered.
6. I also give permission for the Club to administer medication the Participant has to take. I will provide the Club with this medication in the
original container with specific written instructions on the container for its dispensing.
7. This authorization will remain effective during all the Club activities and or transportation to and from Club activities.
8. I understand that it is my sole responsibility to inform the Club in writing of any changes to any of the information submitted on this form.



MEMBERS NAME ______________________________________________School__________________________________
Grade _______Birthday (M/D/Y) _______________ Cell # __________________E-mail _________________________________
Address_________________________________________________________________ City ________________ Zip_________
Phone (____)_______________________Parent‘s Cell # (____)______________________ Work # (____)___________________
Parent E-mail ____________________________________________________________________________________________
Father’s First & Last Name__________________________________ Mother’s First & Last Name __________________________
In an emergency & you cannot be reached, notify_______________________________________ Phone # (____)_____________

HEALTH HISTORY
! Allergies (insect bites/bee stings, medication, etc.)_________________________________________________________________________
! Date of last Tetanus_____________
!Other Conditions - (Epilepsy, Diabetes, Chronic Asthma, Heart Condition, Hay Fever, Physical Limitations, etc.) _____________________
!If your child has any of the above conditions please give details (i.e., include normal treatment instructions) ____________________________
________________________________________________________________________________________________


RESTRICTIONS
Are there athletic restrictions? Yes _____ No _____ If yes, what? ______________________________________________________________


MEDICAL INSURANCE
Do you have health insurance? Yes_______ No_______ Primary Care Physician___________________________________________________
Place of Employment___________________________________________________________________________________________________
Insurance Company ______________________________________________________Group#___ ________________ Policy #_____________
Address______________________________________________________________________________ Phone _________________________

Under the penalty of perjury, the Undersigned does warrant to the Club that all the information given on this form is true, current and accurate.

I, as the birth parent/legal guardian of the Participant, have read, understand, and had opportunity to ask questions, and consent to the terms
above and to the minor becoming a Participant.

Parent/Legal Guardian Signature
________________________________________________________________Date_________________________

_____________________________________________________________________________________________________________________
___

I, as an adult, have read, understand, and had opportunity to ask questions, and consent to the terms above as a Member / Participant.

Participant/Member if over 18 years_________________________________________________Date________________________
                        Acknowledgment of FREERIDE Bicycle Club
                             Rules and Safety Requirements

The rules below are intended for the safety of all riders and must be adhered to when participating in the FREERIDE Bicycle
Club Activities. By signing below you agree to abide by these rules and safety requirements while helping other members do the
same.


! All medical and release forms must be completed and signed before participating in any FREERIDE Bicycle Club activities.

! Bike, helmet with strap and other safety equipment must be in proper working order and used at all times to participate in Club activities.

! Bike pegs must be removed from bike prior to participating in club activities.

!Respect must be given to others and their property.

!The use of alcohol, cigarettes, or illegal drugs is prohibited.

!Do not litter or have glass containers in your possession.

!All backpacks and/or duffle bags are subject to search.

!Unruly behavior and foul language will not be tolerated.



Member Signature __________________________________________________________________________Date______________________


Parent/GuardianSignature____________________________________________________________Date____________________

				
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