RAR Philadelphia Media and COVID Consent and Release Form

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The purpose of this form is to gain your consent regarding Media and COVID related items. The completed form is valid for one year.

If you have any questions, please reach out to rar.philadelphia@gmail.com.

Thank you!
~ RAR Philadelphia

Email *

Name and pronouns *

Phone number *

Address *

Today's Date *

YYYY

Emergency Contact (name, pronouns, phone number, relationship) *

*CONSENT*

I hereby grant permission to Radical Adventure Riders and RAR Philadelphia to use stories, photographs and/or video of me taken at any RAR event in publications, news releases, online, and in other communications related to the mission. *

Yes

I grant to Radical Adventure Riders and RAR Philadelphia, its representatives and employees the right to film and take photographs of me and my property in connection with the above-identified subject. I authorize Radical Adventure Riders and RAR Philadelphia, its transferees and sponsors to copyright, use and publish the same in print and/or electronically. *

Yes

I agree that Radical Adventure Riders and RAR Philadelphia may use such photographs and recordings of me with or without my name and for any lawful purpose, including for example such purposes as publicity, promotion, illustration, advertising, and Web content. *

Yes

*COVID-19 LIABILITY RELEASE*

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which Radical Adventure Riders and RAR Philadelphia adheres to comply with.

In consideration of my participation in the foregoing, the undersigned acknowledge and declare the following:

I am fully and personally responsible for my own safety and actions while and during my participation and I recognize that I may in any case be at risk of contracting COVID-19. *

Yes

With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. *

Yes

I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19. *

Yes

Are you vaccinated?

By completing this form, you agree that you have have read, understand and agree with the above *

Yes

Send me a copy of my responses.

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