Familybike Emergency Information, Waiver, Photo Release Form
KIDICAL MASS PARTICIPANT STATEMENT OF UNDERSTANDING

I Acknowledge that I understand the nature of Familybike Seattle’s sponsored Activities at and outside of Familybike (“Activities”) and warrant that I am qualified, in good health, and in proper physical condition to participate in such Activities.

I Acknowledge that some Activities occur on public roads and other facilities on which the risks of travel are to be expected and that some activities occur in a bike shop in which the risks of a shop setting are to be expected.  These “RISKS” include MINOR INJURIES, SERIOUS BODILY INJURIES, PERMANENT DISABILITY, PARALYSIS AND DEATH.  These Risks may be caused by my actions or inactions as well as the actions or inactions of others participating in the Activities.

I ACCCEPT AND ASSUME ALL RISKS FOR LOSSES, COSTS AND DAMAGES I incur as a result of my participation in any Activities including any and all economic or non-economic damages not known to me nor readily foreseeable at this time.

I RELEASE, COVENANT NOT TO SUE, and HOLD HARMLESS Familybike, its administrators, directors, agents, officers, members, volunteers, and employees, other participants, or any sponsors (“Releasees”) for any and all liability related to Activities caused or alleged to be caused in whole or in part by the Releasees.  I further agree that if, despite this release, I, or anyone on my behalf, make such claim against any of the Releases, I will indemnify and hold harmless the Releasees from any and all costs they incur as the result of such claim including, but not limited to, attorney fees and costs.

In case of an emergency, I hereby authorize and give permission to any physician, hospital, health care provider, or other medical personnel selected by the staff of Familybike to provide prompt medical treatment and arrange necessary related transportation. I agree that once I am in the care of medical personnel or a medical facility, Familybike shall have no further responsibility me and I agree to pay all costs associated with such medical care and transportation. I agree to allow Familybike staff to dispense medications to me as needed.

I agree to allow Familybike Seattle to use any photos its agents take of this ride in promotional materials for Familybike Seattle, including photos with me or my children represented.

Email *
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND AGREE TO IT. *
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1st Adult Participant Name (First and Last) *
2nd Adult Participant Name (First and Last) (Optional)
Participating child(ren) and their ages - [e.g., Joe (5), Kate (2)] *
Emergency Contact Name (First and Last) *
Emergency Contact Phone Number (XXX) XXX-XXXX *
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