Roll-Out Rental Agreement

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First and Last Name *

Address *

City *

Zip Code *

Date *

YYYY

Phone Number *

I am accepting the helmet provided to me. *

Yes

No - MUST INITIAL NEXT STATEMENT!!

A PROTECTIVE HELMET HAS BEEN PROVIDED TO ME AND I OPTIONED NOT TO TAKE IT. Please type your initials to agree.

Rental Agreement and Release of Liability

I agree to use the equipment for its intended use and will return it by the agreed date in clean condition to avoid additional charges. I will pay for any damages considered beyond normal wear and tear.

I will be responsible for the replacement at full retail value of any equipment listed on this form but not returned to Roll-Out.

I accept for use the equipment on this form and accept full responsibility for the care of this equipment.

I have made no misrepresentations to this shop regarding this users age.

I understand and am aware that biking and other equipment use is or can be HAZARDOUS activity. I understand that the use of this equipment involves a risk of injury to any and all parts of this users body. I hereby agree to freely and expressly assume and accept any and all risk of injury to the users of this equipment while biking or renting other equipment.

I understand that protective gear being furnished will NOT PROTECT ME at all times or under all circumstances, and that it is not possible to predict every situation in which injury may occur and that its use cannot guarantee this users safety or freedom from injury while using equipment.

I agree that I will release this store from any and all responsibility or liability for injuries or damages to the users of the equipment on this form, or to any other person, I agree NOT to make a claim against or sue this shop for injuries or damages relating to biking or any other rental items and/or the use of this equipment.

ALL RENTALS MUST BE PAID BEFORE EQUIPMENT OR BIKE IS TAKEN.

User's Signature

By typing your name and submitting this form, you are agreeing to the terms listed above.

Parent's Signature if User is a Minor

By typing your name and submitting this form, you are agreeing to the terms listed above.

Is user renting a FUN CYCLE? *

Yes

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