Couples on Wheels Tandem Club - 2018 Membership and Spring Rally Registration
Email address *
Captain Name *
Your answer
Captain Email
Your answer
Stoker Name *
Your answer
Stoker Email
Your answer
Applicants Under Age 18 - The parent or guardian hereby consents to the applicant’s participation and waives and releases all rights for damage as set forth in the waiver. Print applicant's and guardian's name below. Guardian to electronically sign the waiver.
Your answer
Address - Street *
Your answer
Address - City *
Your answer
Address - State *
Your answer
Address - Zip Code *
Your answer
Phone *
Your answer
Waiver - Electronic Signature
Waiver: I understand that there are inherent and other risks of injury or death involved in the sport of bicycling, that injuries are a common and ordinary occurrence of this sport and that death may occur, and I freely assume all such risks of injury and death including but not limited to those presented by the layout of the track or course, and all other conditions of the course, vehicular, motorcycle, bicycle and other traffic, participant activity, first aid or rescue operations and course conditions. In consideration of being permitted to participate in any of the Couples on Wheels Tandem Club, Inc. events, I personally, and on behalf of my heirs, personal representative, successors, and assigns hereby release, waive, discharge and covenant not to sue all organizers, promoters, sponsors, participants and all other persons and associations connected with a Couples on Wheels Tandem Club, Inc. event including but not limited to the officers, directors, agents, employees, predecessors, successors and assigns (hereinafter referred to as the released parties) for any and all injuries or damages of any kind whatsoever including death suffered by me as a result of my participation in a Couples on Wheels Tandem Club, Inc. event including but not limited to injuries, damages and/or death caused by the negligence of the released parties. I agree that sending this form electronically constitutes agreement with the waiver above, as though I physically signed the form.
Captain Name/Electronic Signature *
Your answer
Date *
MM
/
DD
/
YYYY
Stoker Name/Electronic Signature *
Your answer
Date *
MM
/
DD
/
YYYY
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service