Rider Name _________________________________________
Mailing Address ______________________________________
City __________________ ST ______________ Zip__________
Phone ______________________________________________
Email _______________________________________________
Passenger ________________________ Phone ______________
Bike Make/Mode ______________________________________
EVENT REGISTRATION/RELEASE FORM
For, and in consideration of, their agreement to allow me to participate with them in a motorcycle ride events, the receipt and sufficiency of which is acknowledged by signature hereon, I freely, on behalf of myself, my heirs and estate, fully and finally release and hold harmless I AM DOM Foundation, directors and members associated with any and all ride events from any and all liability, claims, demands suits, whether known or unknow.
In signing this document, I represent that I am fully knowledgeable of the danger and hazards associated with riding motorcycles. I certify that I am duly licensed and competent to operate a motorcycle in a safe manner, and the vehicle is in a safe operating condition. I will be riding on public streets/highways and am solely responsible to determine the speed and operational characteristics of my motorcycle while participating in the ride. I, hereby release and hold harmless I AM DOM Foundation executives or members, against any and all claims, causes of action, or any other liability of any kind arising from my activity of riding a motorcycle.
I certify that I have no known physical or mental impairment that may affect my safety or the safety of the group and that I am 21 years old or older. I have prepared for participation in the event(s). I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers of the event(s), in which I may participate and that it will govern my actions and responsibilities at said event.
I am licensed and competent to operate a motorcycle in a safe manner and my license has all motorcycle endorsements or certificates required by my state of residence. I certify that I have all the insurance required by law to cover all medical claims, the motorcycle and any other equipment and any damage or liability I may ultimately be found responsible for, during all travel to the point of my entry into the ride, the ride, the period between the end of the ride, and my final destination.
I understand that the choice of wearing a helmet or other protective gear is solely my own and that I am responsible for my compliance with all state laws, including those regarding helmets. I certify that I am not under the influence of any narcotic, alcohol, or other drugs that may impair my understanding or judgement and that I will at any time during the ride operate my motorcycle under the influence of any drug or alcohol. II also understand that is Waiver and Release is in in force for the duration of the ride and covers any and all activities.
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Motorcycle Operator Signature Date
________________________________________________ ___________________________
Motorcycle Passenger Signature Date