PEDAL POSITIVE YOUTH Release and Waiver Form (Online)
Parents/Guardians - Thank you for you interest in our events! Please complete this release and waiver form prior to your youth participating in our event.

We "positively" look forward to riding with you!

PRIVACY: This information will only be viewed/used by Pedal Positive organizers for official activities.
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Email *
NAME OF EVENT *
DATE OF EVENT *
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FIRST NAME of YOUTH PARTICIPANT *
LAST NAME of YOUTH PARTICIPANT *
AGE of YOUTH PARTICIPANT *
FIRST NAME of Parent/Guardian signing this waiver *
LAST NAME of Parent/Guardian signing this waiver *
PHONE NUMBER (Why?: So we know how to reach you during events, if needed) *
CITY *
STATE *
EMERGENCY POC NAME (Why?: So we know who to contact during an event emergency) *
EMERGENCY POC PHONE (Why?: So we know who to contact during an event emergency) *
PEDAL POSITIVE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND CONSENT AGREEMENT
IN CONSIDERATION of being permitted to participate in any way in Pedal Positive (“Club”) sponsored Bicycling Activities (“Activity”), I, acting on behalf of the youth participant listed above, myself, personal representatives, assigns, heirs, and next of kin:

1. ACKNOWLEDGE, agree, and represent that I understand the nature of bicycling activities and that I am qualified, in good health and in proper physical condition to participate in such activity. I further acknowledge that the activity will be conducted over public roads and facilities open to the public during the activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe I will
immediately discontinue further participation in the activity.

2. FULLY UNDERSTAND that: (a) BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ("risks"); (b) these risks and dangers may be caused by the youth participant's or my own actions, or inaction's, the actions or inaction's of others participating in the activity, the condition in which the activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES EITHER NOT KNOWN TO ME OR NOT READILY FORESEEABLE AT THIS TIME; AND I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND RESPONSIBILITY FOR LOSSES, COSTS AND DAMAGES I incur as a result of my participation (or that of the minor in the activity).

3. HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE the Club, the League of American Bicyclists, their respective administrators, directors, agents, officers, members, volunteers, other participants, advertisers, and if applicable, owners and lessors of premises on which the activity takes place (each considered one of the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY,
ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses,
attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

4. The youth participant listed above WILL wear a certified helmet when riding a bicycle on a club ride or event. He/she will obey all traffic laws and regulations. I understand that if they leave the route during a club event, they are no longer on the ride.

PHOTO RELEASE

I hereby grant the Club permission to use the above-listed youth participant's likeness in a photograph in any and all of its publications, including website entries, without payment or any other considerations. I understand and agree that these materials will become the property of the Club and will not be returned. I hereby irrevocably authorize the Club to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing the Club’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge the Club from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have by reason of this authorization.

I AM 18 YEARS OF AGE OR OLDER ACTING ON BEHALF OF THE YOUTH PARTICIPANT LISTED ABOVE AND AM COMPETENT TO CONTRACT IN MY OWN NAME. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
By checking "I agree" below, you certify that this serves as your electronic signature and that you have read, understand, and agree to the above Pedal Positive liability waiver and release. *
A copy of your responses will be emailed to the address you provided.
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