Fill and Sign the Claims Accidental Bicycle Form

WaiverPage 1 of 2 Waiver, Assumption of Risk and Release of Claims for Future Accidental Injuries or Death by Individual Applying to Rent a Bicycle (Includes Consent of Parent or Guardian of a Minor) Whereas, the undersigned of , (Name of John Doe) (Street Address) , wishes to rent a bicycle from Acme Bicycles, Inc. , (City, County, State, Zip Code) a corporation organized and existing under the laws of the state of , (Name of State) with its principal office located at , referred to (Street Address, City, County, State, Zip Code) herein as Acme; andWhereas, I acknowledge that cycling is an inherently dangerous sport in which I participate at my own risk; andWhereas, Acme will not rent a bicycle to me unless I sign this waiver, release and assumption of risk agreement; andWhereas, it is my intention to ride any bicycle I rent from Acme in and around the city of , hereinafter referred to as City ; and (Name of City and State) Whereas, I acknowledge that City does not, will not, and has no duty to, insure or guarantee that I will not have an accident resulting in serious injury or death while renting or riding said bicycle;Now, therefore, the undersigned does hereby agree to, covenant to, and represent the following: 1.I, on behalf of myself, my heirs, assignees and personal representatives, do release and forever discharge Acme and City, their employees, officers, and agents (all of which are hereinafter jointly and severally referred to as Released Parties) from any and all liability, claim, loss, cost or expense, arising directly or indirectly from, or attributable in any legal way to, any negligence, action or omission to act of Released Parties that results from my rental of said bicycle.2.I, on behalf of myself, my heirs, assignees and personal representatives, do hereby waive and promise not to sue on any such claims against Released Parties arising directly or indirectly from or attributable in any legal way to, any negligence, action or omission to act of Released Parties that results from my rental of said bicycle.3. I currently have no known physical or mental condition that would impair my capacity to safely use said bicycle as intended or expected except for : (specify, and if none write “NONE”) WaiverPage 2 of 24. I hereby assume all risks associated with using this Bicycle and I do release the Released Parties for any injuries to me that may occur during my use of said Bicycle. I certify that the information on this document, as entered by me, is truthful.5. I, on behalf of myself, my heirs, assignees and personal representatives, agree to indemnify and save Released Parties harmless for any and all liability, claim, loss, cost or expense, arising directly or indirectly from, or attributable in any legal way to, my actions or any negligence, action or omission to act of Released Parties that results from my rental of said bicycle.WITNESS my signature on this the day of , 20 . JOHN DOE Acknowledgment before Notary Public (form may vary by state) or have Witness to Signatures AGREEMENT AND CONSENT OF PARENT OR GUARDIAN OF MINOR I, as parent or guardian of the above applicant, represent to the Released Parties that the facts in this document concerning my child or ward are true. I give my permission for my child or ward to rent a bicycle from Acme and further, in consideration of renting said bicycle to my child or ward, I agree individually and on behalf of my child or ward, to the terms of the above Waiver and Release. WITNESS my signature on this the day of , 20 . (Signature of Parent or Guardian) (Printed Name of Parent or Guardian) Acknowledgment before Notary Public (form may vary by state) or have Witness to Signatures