Buddy Pegs Private Lesson Form & Waiver
Please fill out the following information and sign waiver for our Private Lessons.

Sign in to Google to save your progress. Learn more
Email *
Parent/Caregiver Name *
Cell Phone Number *
If this is a Private group Lesson (i.e. Homeschool group), please list the Primary contact name that is handling the details. *
What lesson was purchased
Child First Name & Age *
Childs current riding ability *
You/Your Child's goals from a private lesson. *
Will you child need to borrow one of our bikes?
Column 1
Yes Please.
No, we have our own.
Clear selection
Requested Days and Time during the week.  We will reach out to you via email to confirm date and time. *
Allergies
BUDDY PEGS MINOR WAIVER- You are required to read the following information very carefully, make sure that you understand it fully, and sign it before allowing your child to participate in this activity (All Buddy Pegs Learn To Ride, Bicycle Playdate/Playground programs & demo/rental bike programs)I. parent/caregiver am fully aware that participation in Buddy Pegs Learn To Ride, Bicycle Playdate/Playground, and Demo/Rental bike programs, may result in risk of personal injury or harm to my child.  I knowingly and freely assume all such risks, both known and unknown, EVEN IF ARISING FROM  THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation. I hereby agree to release and hold harmless Buddy Pegs LLC (Releasee) and its officers, employees, volunteers, location hosts, committees and boards, from and against any and all liability, loss, damages, claims, or actions (including costs and attorneys fees) for bodily injury and/or property damage, to the extent permissible by law.  This indemnification and hold harmless agreement shall include indemnity against all costs (including without limitation, reasonable attorney's fees and court costs), expenses and liabilities incurred in or in connection with any such claim or proceeding brought thereon and in defense thereof. In additional consideration of Buddy Pegs LLC making bicycle(s) available to my child or children: 1) I hereby agree to assume all risks and be responsible for any damage, loss or theft, caused by reason of my use, operation and/or possession of the bicycle(s); 2) I hereby waive and forever relinquish any and all rights and claims which I, or my heirs, executors, administrators, successors or assigns may now or in the future have against Buddy Pegs LLC, woom bikes USA, Prevelo Bicycles and any of their respective affiliates, partners, related entities, agents, directors, officers, and employees (collectively the “indemnities”) in connection with any injury, including death, or property damage, which my child may suffer in using, operating, and/or possessing the bicycle. 3) I hereby agree to indemnify the Indemnitees from and and all liabilities, losses, damages, claims, causes of action, costs and expenses (including reasonable attorney’s fees) arising out of or in connection with, directly or indirectly, my use, operation and/or possession of the bicycle. 4) I acknowledge that Buddy Pegs LLC has recommended that protective helmets be worn and has provide same for my use and has informed me that local laws require that a helmet be worn by any person under the age of 18 while on a bicycle. I have read and understand this release, indemnification and hold harmless form.I further certify that my child is in good physical condition, and has no medical or physical conditions that would restrict his/her participation in this activity or program.  I understand that accepting below constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. *
Required
Parent/Caregiver Signature (Full Name)- Legal Electronic 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