R U A C H  B I C Y C L E  C L U B
STUDENT APPLICATION
Sign in to Google to save your progress. Learn more
Email *
Student Name *
Parent Name
Parent/Guardian Number
Medical Issues/Concerns
Emergency Contact
Name For Emergency Contact 1
Number
Name For Emergency Contact 2
Number
Name For Emergency Contact 3
Number
Transportation needed to and from South Park BMX Track:
(please circle) Yes or No *
Required
RELEASE OF LIABILITY AND ASSUMPTION OF RISK
The parent or legal guardian named below (referred to as “I” or “Me”) is the parent or legal guardian of the
minor participant named below (referred to as the “Participant”), and I desire to have the Participant (i) participate in recreational activities and instructions and trainings related to bike riding, bike racing, bike building, and learning science, technology, engineering, art and math through the association with bikes and any other related activities, including without limitation drills, practices, rides and races (collectively, the “Activities”) provided by Ruach Bikes and Burgers, LLC, a Pennsylvania limited liability company (the “Company”), and/or any of the Releasees (as defined herein) and (ii) be offered and
be provided transportation to and/or from the Activities provided by the Company and/or any of the Releasees (the “Transportation”). As lawful consideration for the Participant being permitted by the Company to participate in the Activities, I agree to all of the terms and conditions set forth in this Release of Liability and Assumption of Risk (this “Agreement”).


ASSUMPTION OF RISK. I AM AWARE AND UNDERSTAND THAT THE ACTIVITIES AND THE TRANSPORTATION ARE OR MAY BE DANGEROUS AND INVOLVE THE RISK OF SERIOUS INJURY, INCLUDING BUT NOT LIMITED TO, PERMANENT DISABILITY, DEATH, SEVERE SOCIAL AND ECONOMIC LOSSES, AND/OR PROPERTY DAMAGE (COLLECTIVELY, THE “INJURIES”), WHICH MIGHT RESULT FROM THE ACTIONS, INACTIONS, AND/OR NEGLIGENCE OF OTHERS, CONDITIONS OF THE PREMISES, AND/OR UNKNOWN RISKS REASONABLY FORESEEABLE AT THE TIME, AND I ACCEPT PERSONAL RESPONSIBILITY FOR THE DAMAGES
FOLLOWING ANY SUCH INJURIES REGARDLESS OF CAUSE. I ACKNOWLEDGE THAT ANY AND ALL INJURIES SUSTAINED MAY BE COMPOUNDED BY NEGLIGENT EMERGENCY RESPONSE OR RESCUE OPERATIONS OF THE COMPANY AND/OR ANY RELEASEE. I ACKNOWLEDGE THAT THE ACTIVITIES ARE VOLUNTARY AND I AM AWARE OF THE DANGER INVOLVED AND I HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF SUCH INJURIES, WHETHER CAUSED BY THE NEGLIGENCE OF THE COMPANY, ANY RELEASEE, AND/OR OTHERWISE. I HEREBY AFFIRM THAT THE PARTICIPANT IS IN GOOD HEALTH AND FREE FROM ANY ILLNESS, DISABILITY, OR CONDITION REQUIRING REGULAR MEDICATION OR MEDICAL ASSISTANCE. RELEASE.


STUDENT WAIVER
R U A C H B I C Y C L E C L U B


I HEREBY EXPRESSLY WAIVE AND RELEASE ANY AND ALL CLAIMS, NOW KNOWN OR
HEREAFTER KNOWN IN ANY JURISDICTION, AGAINST THE COMPANY, AND ITS OFFICERS,
DIRECTORS, INDEPENDENT CONTRACTORS, COACHES, TRAINERS, TEACHERS, MANAGERS,
SPONSORS, ASSOCIATED PERSONNEL, EMPLOYEES, AGENTS, AFFILIATES, MEMBERS,
SUCCESSORS, AND ASSIGNS (COLLECTIVELY, “RELEASEES”), ON ACCOUNT OF ANY AND ALL
INJURIES ARISING OUT OF OR ATTRIBUTABLE TO THE PARTICIPATION IN THE ACTIVITIES OR
THE TRANSPORTATION, WHETHER ARISING OUT OF THE NEGLIGENCE OF THE COMPANY,
ANY RELEASEE, OR OTHERWISE. I COVENANT NOT TO MAKE OR BRING ANY SUCH CLAIM
AGAINST THE COMPANY AND/OR ANY RELEASEE, AND FOREVER RELEASE AND DISCHARGE
THE COMPANY AND ALL RELEASEES FROM LIABILITY UNDER SUCH CLAIMS.


Medical


Treatment. I hereby give my consent to have an athletic trainer, a nurse, a coach, any Releasee, and/or
doctor of medicine or dentistry to provide the Participant with medical assistance and/or treatment, and I
agree to be financially responsible for the cost of such assistance and/or treatment. Indemnification. I shall
defend, indemnify, and hold harmless the Company and any Releasee against any and all losses, damages,
liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or
expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to
indemnification under this Agreement, and the costs of pursuing any insurance providers, in every case
incurred by or awarded against any Releasee in a final judgment or otherwise, arising out of or
resulting from any claim of a third party related to the Activities.
Photo Waiver. I hereby grant permission to the Company to take pictures, images, video, and other
media sources during the participation of the Activities, and for the publication of such pictures, images,
video, and other media sources, which may be used for promotional purposes or otherwise as the
Company deems appropriate. Miscellaneous. This Agreement constitutes the sole and entire agreement of
the Company and Me with respect to the subject matter contained herein and supersedes all prior and
contemporaneous understandings, agreements, representations, and warranties, both written and oral,
with respect to such subject matter. If any term or provision of this Agreement is deemed to be
invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not
affect any other term or provision of this Agreement or invalidate or render unenforceable such term or
provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the
Company and Me and our respective successors and assigns.

STUDENT WAIVER

R U A C H B I C Y C L E C L U B

All matters arising out of or relating to this Agreement shall be governed by and construed in accordance
with the internal laws of the Commonwealth of Pennsylvania without giving effect to any choice or
conflict of law provision or rule (whether of the Commonwealth of Pennsylvania or any other
jurisdiction). Any claim or cause of action arising under this Agreement shall be submitted to final and binding arbitration in Pittsburgh, Pennsylvania in accordance with the rules of the American Arbitration Association, before an
arbitrator who is a member of the National Academy of Arbitrators, and the judgment rendered by such arbitrator may be entered in any court having jurisdiction.


BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND ALL OF THE TERMS OF
THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS,
INCLUDING THE RIGHT TO SUE THE COMPANY AND/OR ANY RELEASEE.
I am the parent or legal guardian of the minor Participant named below. I have the legal right to consent
to and, by signing below, I hereby do consent to the terms and conditions of this Agreement.
Name of Minor Participant: *
Signature of Parent or Legal Guardian: *
Printed Name of Parent or Legal Guardian: *
Address of Parent or Legal Guardian: *
Date: *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy