Pedaling the Prairie Bike Rider Waiver

Location
Waller County Fairgrounds
22000 Fairgrounds Road HempsteadTX  77445

Sign in to Google to save your progress. Learn more
Name *
Email *
Assumption of Risk Waiver  
In consideration of the acceptance of this registration, I, the undersigned, acknowledge that my participation in the Pedaling the Prairie ride is voluntary and assume full and complete responsibility for any injury or accident, which may occur, during my participation in the Pedaling the Prairie ride. I certify that I am physically fit, and have not been informed otherwise by any physician or other healthcare provider. I certify that I am sufficiently experienced to ride in the Pedaling the Prairie ride. I HEREBY RELEASE AND HOLD HARMLESS THE SPONSORS, PROMOTERS, EVENT PARTNERS AND ALL OTHER PERSONS AND ENTITIES ASSOCIATED WITH THE EVENT FROM ANY AND ALL CLAIMS, DEMANDS OR CAUSES OF ACTION AS A RESULT OF ANY INJURY OR DAMAGE WHETHER IT IS CAUSED BY MYSELF OR BY THE NEGLIGENCE, IN WHOLE OR IN PART, OF THE SPONSORS, PROMOTERS, EVENT PARTNERS OR ANY OTHER PERSONS OR ENTITIES ASSOCIATED WITH THE EVENT. I agree to wear a helmet. I understand that a bicycle is a legal vehicle in the State of Texas, and I will comply with state vehicle laws. I understand that the risks of a lengthy bicycle tour include, but are not limited to, head injuries, fractures, dehydration, heat exhaustion, heat stroke, heart attack, and other possible minor or major injuries. I consent to emergency medical treatment in the event of injury or illness. I consent to the use of my name and photograph in connection with the Pedaling the Prairie ride in any form, printed or electronic. This agreement shall not be modified orally, or in writing, by any individual. If entrant is under 18 years of age, parent or guardian must sign entry. Children under 18 must be accompanied by an adult.
Rider Signature
(Guardian’s Signature if rider is under 18 years)
*
Required
Rider Digital Signature *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy