Convoy Registration and Waiver
***All riders must sign and date this form to participate
Full Legal Name
Contact Number (In Case of Updates)
August 25, 2018 RELEASE FORM ACCIDENT WAIVER, RELEASE OF LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event(s) described below I agree: I acknowledge that CALEB'S CONVOY is a potentially dangerous activity which can be a test of a person's physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of riders equipment, vehicular traffic, actions of other people including, but not limited to organizers, participants, volunteers, spectators, agents, Caleb Erickson Memorial Fund, Inc. and its officers. These risks are not only inherent to drivers/riders, but are also present for passengers, spectators and volunteers. I hereby assume all of the risks of participating, viewing and/or volunteering in this event.I certify that I am at least 18 years old and am physically fit with no known physical or mental impairment that would prevent me from participating in CALEB's CONVOY. I acknowledge that this Accident Waiver and Release of Liability form will be used by the Caleb Erickson Memorial Fund, Inc., its officers, sponsors and organizers of the event, in which I may participate and that it will govern my actions and responsibilities at said events. I certify that I am not under the influence of any narcotic, alcohol or other drug that may impair my understanding or judgment and that I will not at any time during the event operate my vehicle/motorcycle under the influence of any narcotic, alcohol or drug. I certify that I have fully adequate insurance to cover all medical claims, the vehicle/ motorcycle and any other equipment and any damage or liability I may ultimately be found responsible for, during all travel to the point of my entry into CALEB's CONVOY at the Waseca American Legion and the Convoy ride. I further certify that I have all the insurance required by law and I am licensed and competent to operate a vehicle/ motorcycle in a safe manner and my license has all vehicle/motorcycle endorsements or certificates required by my state of residence.In consideration of my being permitted to participate in CALEB'S CONVOY, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (a) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me for any claim of ordinary negligence arising out of my participation in the event or during my traveling to and from the Convoy ride, THE FOLLOWING ENTITIES OR PERSONS: The Caleb Erickson Memorial Fund, Inc., its officers, directors, ride organizers, sponsors, representatives, agents, volunteers (the "Releasees") and (b) indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of any of my actions during this event. This shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I understand that this Accident Waiver and Release, and Assignment of Claims is limited to claims for ordinary negligence and in no way shall be construed to release claims for conduct that constitutes greater than ordinary negligence, conduct that constitutes reckless or grossly negligent conduct, or willful, wanton or intentional acts. If, despite this release, I, or anyone on my behalf, makes a claim for ordinary negligence against the Releasees, I agree to indemnify and save and hold harmless the Releasees and their insurance carrier, and each of them from any litigation expenses, attorney's fees, loss, liability, damage, or costs they may incur due to the claim made against any of the releases, whether the claim is based on the negligence of the Releasees or otherwise.I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and or illnesses during CALEB'S CONVOY. I agree to pay for any and all costs related to medical response, treatment and transport on my behalf.If driving/riding a motorcycle, I certify I will wear the personal protective equipment while operating my motorcycle at this event that is or may be required by the United States or Minnesota and that my motorcycle and all required personal protective equipment are in safe operational condition. I agree to abide by the directions/rules given by the organizers of this event and understand that my privilege to ride may be removed without refund if I am in violation of the rules set forth or acting/performing in an unsafe manner, or any manner disruptive to the operation of the event. I hereby release The Caleb Erickson Memorial Fund, Inc. from any and all claims based upon or arising out of the use, reproduction, distribution, display or performance of all or any part of the photographs or recording, or any derivative thereof, including any claim of invasion of privacy or right of publicity. MISCELLANEOUS: This document contains the entire final agreement of the parties and it supersedes all prior or contemporaneous agreements, representations, or understandings. I understand that this Agreement extends to all acts of ordinary negligence by the Releasees and is intended to be as broad and inclusive as is permitted by the laws of the State of Minnesota. In the event that any term of this Agreement is held to be invalid, illegal, or unenforceable in any respect, that holding shall not affect the validity, legality, and enforceability of any other term. I understand that this agreement may not be waived or modified in whole or in part except by written consent of the undersigned and the Caleb Erickson Memorial Fund, Inc. A waiver of one term shall not be construed either as a continuing waiver or waiver of any other term. **I hereby certify that I have read this Waiver, Release and Assignment of Claims in its entirety. My signature below indicates that I fully understand it and agree to its contents. Please sign using full legal name
Date of Signature
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service