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PROUDLY SERVING THE NEEDS OF CYCLISTS SINCE 1972

1907 Deptford Center Road, Deptford NJ 08096 

856.228.7800

Sales | Service | Satisfaction

 

Peddler’s Shop Cycling Club

Release of Liability

THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS, READ IT CAREFULLY BEFORE SIGNING.

By signing below, I represent and warrant that I am 18 years old or over and understand that this non-competitive ride involves bicycle riding as part of a group on public streets and off-road terrain where hazards exist. I agree it is my sole responsibility to be familiar with the ride route and terrain. No representation has been made to me by the Peddler’s Shop Cycling Club., any sponsors, organizers or promoters of this ride, or their respective agents, officers, directors, employees, officials or representatives (hereinafter collectively “Releases”) considering the condition and adequacy of all my equipment and my riding skill. Releases have represented to me that the course condition is advanced level and suitable only for very experienced and skilled riders. I understand and agree that I must continually ride so as to neither endanger myself or others. I also understand that this ride may take place after dark and am fully aware of the risks of riding at night. During the ride I will ensure my bicycle is equipped with a working headlight and all reflectors required by law, and will wear an ANSI, SNELL, or ASTM certified helmet. I assume all responsibility for the selection, condition and adequacy of all my equipment and warrant and represent that such equipment is in good condition and adequate for this ride. I have no physical or medical condition which to my knowledge, would endanger myself or others if I participate in this event, or would interfere with my ability to participate in this ride.

I acknowledge that cycling is an inherently dangerous sport and fully realize the dangers of participating in a group bicycle ride and FULLY ASSUME THE RISKS ASSOCIATED WITH SUCH PARTICIPATION INCLUDING, by way of example, and not limitation, the following: collision with pedestrians, vehicles, other riders, fixed or moving objects, ground surface hazards, darkness, weather conditions, equipment failure, inadequate safety equipment, RELEASEES’ OWN NEGLIGENCE, and the possibility of serious physical and/or mental trauma or injury associated with cycling.

In consideration of my being permitted to participate in this ride, I, for myself, my heirs, executors, administrators, legal representatives, assignees, and successors in interest (collectively “successors”) hereby WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNIFY AND NOT TO SUE RELEASEES for any claims INCLUDING CLAIMS ARISING FROM THE RELEASEES’ OWN NEGLIGENCE (active or passive), which I have or which may hereafter accrue to me or my successors and from any and all damages which have been sustained by me directly or indirectly in connection with, or arising out of my participation in or association with this ride, or travel to or return from this ride. This agreement cannot be modified.

Children under 18 must ride with an adult who signs this form on their behalf.

CONSENT AND RELEASE OF PARENT OR GUARDIAN

My Child is capable of completing this ride, and being the legal guardian or parent of this child participating on this ride, I consent to my Child’s participation. I HAVE READ AND UNDERSTAND THE RELEASE ABOVE. In consideration of allowing my child to participate, I consent to it and agree that ITS TERMS SHALL LIKEWISE BIND ME AND MY CHILD.

DATE                                                                

RIDER (over 18) OR GUARDIAN (print name)

 

AGE

 

EMERGENCY PHONE #

 

RIDER (over 18) OR GUARDIAN (sign)

 

Print:

Sign: