hold harmless pg 1 - Thevillagesinc.org

thevillagesinc.org

hold harmless pg 1 - Thevillagesinc.org

Throttle for Teens Benefit RideMay 19th, 2012Hold Harmless AgreementRider’s Name:___________________________DOB/Age:______________________________Passenger’s Name:__________________________DOB/Age:_________________________________Emergency Contact Name:_______________________________Phone number:________________________________________Make/Model of Motorcycle:___________________________License Plate Number:_______________________________Motorcycle Insurance Carrier:_________________________Policy Number:_____________________________________Driver“I, the undersigned, certify that the above listed motorcycle listed above is legally registered inaccordance with state, city, and/or local licensing and registration requirements. I further certifythat I carry property and liability insurance for myself, my passengers, and the motorcycle whichmeets at least the minimum state, city, and/or local insurance requirements. I also certify that Icarry a valid driver’s license with either a cycle endorsement or a valid Motorcyclist TemporaryInstruction Permit in accordance with state, city, and/or local laws. I further certify that I have thelegal right to utilize the listed motorcycle. I accept full responsibility for my safety and conduct,and the safety and conduct of any who may be participating as my guest or passenger in thisevent. I realize that these are requirements for my participation in this event.”_________________________________Signature of Driver_______________________Date


Passenger“I am participating as a passenger of the following participant/driver_________________________________ who has certified their compliance with requirementsof the event by signing this waiver form. I will not be operating a motorcycle during this event,but am participating in this event strictly as a passenger.”________________________________Signature of Passenger__________________________DateDriver and Passenger“I/We, the undersigned, agree that The Villages, Inc. and “Throttle for Teens” benefit ride shallnot be liable or responsible for damage to property or injury to persons including myself and/orpassenger during this event, even where the damage or injury is caused by negligence (exceptwillful neglect). I understand and agree that participation in this event is voluntarily, and is atmy own risk. I release and hold The Villages, Inc. and “Throttle for Teens” benefit ride harmlessfor any injury loss to my person or property that may result through my participation in thisevent. I understand that this means that I agree not to sue The Villages, Inc. or anyone associatedwith the “Throttle for Teens” benefit ride for any injury resulting to myself or my property inconnection with this event.”_____________________________________Signature of Driver_____________________________________Signature of Passenger____________________________Date____________________________Date

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