Wisconsin State Firefighters Memorial - Wisconsin Rapids, WI
 
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Wisconsin State Firefighters Memorial

Ride Waiver Release and Consent

Safety is our primary concern.  Please observe all federal, state, and local laws.  Ride safely and defensively.  We request that you wear a helmet appropriate clothing and eye wear and that your passenger does the same.  If you and/or passenger choose to ride without a helmet, you do so at your own risk.  Please ride with your headlight on at ALL times and never ride under the influence of alcohol or drugs.

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NAME OF EVENT:  2010 Wisconsin State Firefighter Memorial Ride

DATE:  Saturday, July 24, 2010

STARTING LOCATION:    Stocks Harley Davidison

OTHER LOCATIONS:    St. Nazianz, Elkhart Lake, Random Lake Fire Departments

ENDING LOCATION:  Newburg Firemen’s Park, Newburg, WI

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In consideration of the Wisconsin State Firefighters Memorial Inc. and its Fund Raising Committee, Stocks Harley Davidson St. Nazianz Fire Department, Village of St. Nazianz, Elkhart Lake Fire Department, Village of Random Lake, Random Lake Fire Department, Village of Elkhart Lake, Newburg Fire Department, Inc., Cedarburg Emergency Response Team, Hometown Towing, ASAP Towing, Waubeka Fire & Rescue, and any of the sponsors of this event, permitting [me] [my child ________________________________, who is under the age of 18] to participate in the above named event.  I hereby, and for [my][my child's] heirs, executors, administrators, their representatives, and all legal guardians, WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS OF ANY NATURE FOUNDED IN WHOLE OR IN PART UPON ANY TYPE OF NEGLIGENCE, that [I] [my child] may have against the above parties, its directors, officers, employees, agents, chapters, assignees, licenses, volunteers and any cooperating entities, their representatives, heirs, executors, administrators, successors, and assigns [the "Released Parties"] arising out of or resulting from any and all injuries or damages of any nature, including death which [I] [my child] may suffer while taking part in the event or any activities connected with the event.  FURTHER IT IS UNDERSTOOD THAT THIS MEANS BY ALL PARTIES THAT I AGREE NOT TO SUE any or all of the Released Parties in connection with the event.

 

[I AM] [MY CHILD IS] EXPERIENCED IN AND FAMILIAR WITH THE OPERATION OF MOTORCYCLES AND FULLY UNDERSTAND THE RISKS AND DANGERS INHERENT IN MOTORCYCLING. [I am] [my child is] voluntarily participating in the event and I expressly agree to assume sole responsibility for the safe and successful operation of my motorcycle, and to accept the entire risk of any accidents or personal injury, including death, which[I] [my child] might suffer as a result of my participation in the event.  I further understand that [I] [my child] assume[s] all risks in participating in the event.

 

Consent also is hereby given to use [my] [my child's] name, picture, portrait, likeness, writings or biographical information, and audiotape and/or videotape recordings and sound or silent motion pictures of [me] [my child] in any medium of editorial, educational, promotional, and advertising purposes, for the solicitation of contributions, and/or for any other purposes in furtherance of the corporate purposes and objectives.

 

By signing this document, I certify that I have read this document and fully understand it, and that I am not relying on any statement or representations of any of the Released Parties.  This document shall be binding upon me, my [my child's] heirs executors, administrators, and assigns [and all legal guardians of my child].

 

RIDER                                                                                            PASSENGER

___________________________________________                    _______________________________________________

Print Name of Rider                                                                      Print Name of Passenger

___________________________________________                    _______________________________________________

Home Address                                                                              Home Address

 

_______________________________________________________                                                 ______________________________________________________________________

City, Sate & Zip Code                                                                                                      City, Sate & Zip Code

 

______________________________________________________________________                   ______________________________________________________________________

Phone Number                                                                              Phone Number

 

______________________________________________________________________

E-mail Address

 

______________________________________________________________________                   ______________________________________________________________________

Signature of Rider                                                                         Signature of Passenger

 

______________________________________________________________________                   ______________________________________________________________________

Signature of Parent/Legal Guardian if Rider is Under 18     Signature of Parent/Legal Guardian if Rider is Under 18

Copyright © 2010 Wisconsin State Firefighters Memorial. All rights reserved. | PO Box 248 Wisconsin Rapids, WI 54495 | info@wsfm.org