Public Health

Partnership of

Licking County

I ACKNOWLEDGE that the bike ride I am going to participate in involves a dangerous activity. I acknowledge that this ride carries with it the potential for death, serious injury, property damage, and property loss. I hereby assume all the risks of doing this ride, regardless of their cause. I promise to ride in a safe and prudent manner, so as not to endanger myself or others. In consideration of my application to participate in this ride, I hereby execute this Waiver and Release from Liability on behalf of myself, my personal representatives, my administrators, my heirs, my next of kin, my survivors, my successors, and my assigns, as follows:

A. I WAIVE, RELEASE, DISCLAIM and FOREVER DISCHARGE from any and all liability for me while riding in any rides sponsored by the Public Health Partnership of Licking County and the Licking County Health Department, the following entities or persons: employees, volunteers, representatives, agents, assigns, funders and sponsors of event, together with vendors and manufacturers, and their respective directors, officers, employees, representatives, agents, and assigns.

B. I INDEMNIFY AND HOLD HARMLESS the entities and persons specified in paragraph A above from any and all liability, loss, demand, claim or action at law or in equity that may hereafter be made or brought by those individuals or entities as a result of any of my actions during this ride.

C. I CONSENT to receive medical treatment that may be deemed advisable as a result of any injuries I receive during this ride and agree that I am solely responsible for all costs, including diagnosis, treatment, medical transportation, and evacuation, that may become necessary for me or another person as a result of any of my actions during this ride.

D. I AGREE that any photographs and video footage taken of me during my ride, as well as any written documents I submit to the event sponsors, may be printed, reproduced and published in any manner anywhere without any further consent by me or my family members and without any compensation to me.

E.  This waiver shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby certify that I have read this document; and I understand its content.

F. PARENT / LEGAL GUARDIAN WAIVER FOR MINORS: The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.

G. I CERTIFY that I have read this document, understand its contents in their entirety and have executed this document below without reservation or duress.

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