MINORS - OPEN COURSE - BIKE ARLINGTON HEIGHTS PERMISSION FORM RELEASE AND INDEMNIFICATION
MINORS - OPEN COURSE - BIKE ARLINGTON HEIGHTS PERMISSION FORM RELEASE AND
INDEMNIFICATION

(FOR MINORS – MUST BE COMPLETED BY A PARENT)

Please fill out the form below for a minor under the age of 18 to participate in the Bike Arlington Heights
event held on Saturday, May 12, 2018. Thank you for your participation!

WHEREAS, "Minor”, as of the date of the Bike Arlington Heights event, will be under the age of 18
years old and would like to participate in Bike Arlington Heights, a recreational bike ride (“Event”)
WHEREAS, the Village of Arlington Heights, a municipal corporation, ("Village") is willing to grant
permission to participate in the event,
NOW, THEREFORE, in consideration for permission to participate in this event and for other good and
valuable consideration herein acknowledged, the undersigned agrees as follows:
I give my minor permission to participate in this event;
I understand that no roads are closed. All riders must obey all traffic laws and will be crossing busy
streets that are open to vehicular traffic;
I understand that there are inherent risks involved in this event;
I understand and agree that if my child suffers any injuries, payment for medical care will be my
responsibility;
I understand and agree that despite careful and proper preparation, instruction, medical advice,
conditioning and equipment, there is still a risk of serious injury when participating in any recreational
activity/program. Understandably, not all hazards and dangers can be foreseen. I understand that
certain risks, dangers and injuries due to inclement weather, slip and falls, poor skill level or
conditioning, carelessness, horseplay, unsportsmanlike conduct, premises defects, inadequate or
defective equipment, inadequate supervision, instruction or officiating, and all other risks inherent to
indoor and outdoor recreational activities/programs exist. I recognize that it is impossible for the Village
to guarantee absolute safety;
I hereby release and hold harmless the Village of Arlington Heights and its officers, agents, and
employees from any and all liability, losses or damages, including attorneys' fees and costs of defense
the Village may suffer as a result of claims, demands, suits, actions or proceedings of any kind or nature,
in any way resulting from my child’s participation in this event. I will, at my own expense, appear,
defend and pay all fees of attorneys and all costs and other expenses arising therefrom or incurred in
connection therewith; and, if any judgments shall be rendered against the Village in any such action, I
will, at my own expense, satisfy and discharge same.

By signing below, you certify that you have read
and agree to the terms presented herein:

I certify I agree to the terms of the Arlington Heights Release & Indemnification Form for the Bike
Arlington Heights Event

By checking the box below, you certify that you have read and agree to the terms of this form. *
Required
Please check which distance you plan to ride: *
Parent's last name *
Your answer
Parent's first name: *
Your answer
Parent's Street Address: *
Your answer
Parent's Zip Code: *
Your answer
Parent's phone number: *
Your answer
Parent's email address: *
Your answer
Minor's last name: *
Your answer
Minor's first name: *
Your answer
Minor's date of birth: *
Your answer
Thank you!
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