2022 The Brown Bike Girl Waiver
PHOTO RELEASE & RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY, AND PARENTAL CONSENT AGREEMENT ("Agreement") for PARTICIPATION in of THE BROWN BIKE GIRL, CORP in the YEAR 2022
(Form is to only be used for Individual Adults or for Adults on behalf of Minors)

IN CONSIDERATION of being permitted to participate in any way in sponsored Bicycling Activities ("Activity")
sponsored, planned, or led by owners or representatives of The Brown Bike Girl, Corp., I, for 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, in good health, and in proper physical condition 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, the actions or inactions of others participating in the Activity,
the conditions 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 not 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 may incur as a result of my participation in the Activity.

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE The Brown Bike Girl. Corp, its respective
administrators, directors, agents, officers, members, volunteers, and employees, other participants, any
sponsors, co-sponsors, or co-organizing persons or entities, advertisers, and, if applicable, owners and lessors
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 IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT
RESCUE OPERATIONS. And, I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY,
ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of
the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation
expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

4. I ALSO ACKNOWLEDGE THAT IN ORDER TO PARTICIPATE in any individual Bicycle Activity lead, planned, or
facilitated by The Brown Bike Girl that I abide by the rules defined by the ride captain/leader on the given day
of activity which includes the commitment to wear a helmet and obey traffic laws, ride courteously, and
endeavor to use the road communication hand signals as promoted by the League of American Bicyclists, and/
or other form of verbal and visual direction indication.

5. I ACKNOWLEDGE AND HEREBY GRANT PERMISSION AND THE RIGHT of USE OF MY PHOTOGRAPHIC, VIDEO,
AND AUDIO representation, image and likeness captured in association with the participation of Bicycling
Activities and other events sponsored by The Brown Bike Girl, Corp to be used by the corporation for
commercial and educational use without payment or any further requirement on consent. I waive the right to
royalties in accordance with the use of my likeness or image by The Brown Bike Girl, Corp which may be used
in but not limited to website, advertise, fliers, and conference presentations.

** To accept, sign the attestation and provide the required information below **
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What is the start date of the event for which you are signing this waiver?   (El Barrio Bikes Training - 3/15/22, Car Free Earth Day- 4/23/22, Family Day Kite Ride - 5/14/22, East Brooklyn Biking Club - 5/9/22) *
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(Read enter your FIRST and LAST name in the field below) I AM 18 YEARS OF AGE OR OLDER, HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT, UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT, HAVE SIGNED IT VOLUNTARILY 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. I AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. *
What is your complete address?( Including apt/unit # and zipcode) *
What is your phone number? (Including area code) *
What is your email?  (Please provide an email other than yahoo or aol domains if possible.  These frequently cause "bouncebacks")
Please mark today's date:
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EMERGENCY CONTACT:  What is the name and phone of a person who is NOT PART OF THIS EVENT whom we can contact in event of emergency? *
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