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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. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- NAME OF EVENT: 2008 Wisconsin State Firefighter Memorial Ride DATE: Saturday, July 26, 2008 STARTING LOCATION: Mischler’s Harley-Davidson, BMW, & Buell, Inc. OTHER LOCATIONS: OTHER LOCATIONS: Markesan Fire Department, Markesan Emergency Government, Southern Green Lake County Ambulance, Neshkoro fire Department, Mead-Rath-Gutke Post 339 American Legion Post of Almond, Almond Fire Department, Almond Lions Club, Inc., WSFM Inc. ENDING LOCATION: Wisconsin State Firefighters Memorial at Ben Hanson Park in Wisconsin Rapids ----------------------------------------------------------------------------------------------------------- In consideration of the Wisconsin State Firefighters Memorial Inc. and its Fund Raising Committee, Markesan Fire Department, Markesan Emergency Government, Southern Green Lake County Ambulance, Neshkoro fire Department, Mead-Rath-Gutke Post 339 American Legion Post of Almond, Almond Fire Department, Almond Lions Club, Inc., and any other 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. I UNDERSTAND THAT THIS MEANS 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 UNDERSTANDS 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 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]. _____________________________________ ______ _____ _ ________ _________________________ 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
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