I,
(print name) __________________________________, understand that during my
relationship with PIVOT TN I will always conduct myself in an honest and
accountable manner, am at least 18 years of age, and consent to participation
in the bike program with PIVOT TN. I hereby give my consent to receive services
and volunteer; I acknowledge and agree that I am doing so at my own risk and my
health and safety with respect to such services are my sole responsibility. I
understand and assume all the risks associated with my decision to volunteer
and receive a bike. In exchange for the promise of receiving a bike for myself
and on behalf of my heirs, executors, administrators and personal
representatives, I hereby waive, release, discharge and hold PIVOT TN and
partnering organizations harmless from any and all liability for any and all
injuries, including damages or claims relating to or resulting from my receipt
of a bike in the A2B Cycle Program, now or in the future, foreseen or
unforeseen. I understand and acknowledge that I am fully aware of and assume
the risks riding the bike provided by PIVOT TN. I understand that 2 hours of service will be
completed before receiving a bike and will be done at 100% effort. I indemnify
PIVOT TN for any damage and harm to the person and property of third parties as
a result of my participation in this volunteer bike program. PIVOT utilizes the
Unite us platform for resource management. By signing below, you agree to
having access to additional resources by the sharing of information with a
Network of health and social service partners powered by Unite Us
software. This Agreement shall be subject to, and construed in accordance
with, the laws of the State of Tennessee. I agree to return the bike if no longer needed and when I am no longer a student of Maryville College.