Downtown Breakaway Liability Release Waiver & Emergency Contact Submission
Thank you for riding in the 2021 Downtown Breakaway, presented by Potomac Pedalers. Please review the following liability release form and indicate your agreement with it in order to participate in the ride.
Additionally, please submit your emergency contact information in case of any incident requiring the ride leaders to make contact. This information will only be viewable by official ride leaders of the Downtown Breakaway and only used in case of emergency.
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RELEASE and WAIVER AGREEMENT
Release and Waiver for Adult with or without a Minor of Liability, Assumption of Risk, and Indemnity Agreement ("Agreement”).
NOTE: New updates for COVID-19 constitute items 4 thru 12.
In consideration for being permitted to participate in any way in any bicycle ride or event sponsored by or associated with Potomac Pedalers Touring Club, Inc., I, myself, my personal representatives, assigns, heirs, and next of kin:
1. ACKNOWLEDGE, agree and represent that I understand the nature of Bicycling Activities and that I am qualified to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.
2. FULLY UNDERSTAND that: (a) BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ("RISKS”); (b) these Risks and dangers may be caused by my own actions, or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES” NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity.
3. HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Club, its administrators, directors, ride leaders, volunteers, agents, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and releasers of premises on which the Activity takes place (each considered one of the "RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR PART BY THE NEGLIGENCE OF THE "RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS.
4. I attest that to the best of my knowledge; I do not have COVID-19 at the time of attending this PPTC event.
5. I also attest that I have not knowingly been in contact with or exposed to any known carrier of COVID-19 within the past 14 days.
6. I agree that I will not knowingly expose others to any illness I may have or be at risk to have.
7. I will follow all PPTC requirements to reduce any exposure and possibility of contracting or spreading the virus.
8. I will follow City, County and/or State guidelines with respect to COVID-19 that have jurisdiction in the area in which the PPTC event is taking place.
9. If any of the above should change prior to my arrival at the PPTC event or during my participation in the PPTC event that is the subject of this consent, I will inform PPTC and proceed accordingly in light of the new information.
10. I agree that I am attending this PPTC event entirely at my own choice and assume all risk and full responsibility for my own health, wellbeing, and safety.
11. I agree that PPTC (board members, members, and their designees) is in no way liable for any present or future COVID-19 exposure incurred at any time by any person, in attendance or not in attendance, during or after this PPTC event.
12. Further, I hereby indemnify and hold harmless PPTC (board members, members, and their designees) from all COVID-19-related claims by or liability to any third party arising out of my participation in the PPTC event. Any liability to anyone for any COVID-19 incident involving myself or the actions of other participants will be my sole responsibility. I assume all financial liability and assume all and any financial costs associated with my actions.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF BICYCLING ACTIVITIES AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE’S FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART Y THE NEGLIGENCE OF THE "RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST AS MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.
Indicate your agreement with these terms by ENTERING YOUR INITIALS on the line below.
Mobile Phone Number
Emergency Contact Name
Emergency Contact Phone Number
Thank you for providing this information. See you at the ride!
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