Down loadable copy of Tues Night Youth waiver: Tues night waiver
Skookum Cycle and Ski Tues Night Youth Rides, the Summer of 2017
DATE: ______ / ______ / 2017
LAST NAME: FIRST NAME: E-MAIl:
ADDRESS: CITY: PROVINCE:
POSTAL CODE: PHONE: GENDER:
2017 RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
(hereinafter referred to as the ‘‘Release Agreement’’)
BY SIGNING THIS DOCUMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT
PLEASE READ CAREFULLY!
Skookum Cycle and Ski ltd and all owners or occupiers of venues or premises where Cycling Activities (as defined herein) take place, and their respective directors, officers, members, guide volunteers, volunteer instructors, employees, instructors, guides, volunteers, officials, course workers, first aid attendants, agents, representatives, independent contractors, subcontractors, suppliers, sponsors, successors and assigns (all of whom are hereinafter collectively referred as ‘‘the Releasees’’)
In this Release Agreement the term ‘‘Cycling Activities’’ shall include all activities, events, competitions, training rides, tours, programs, workshops, lessons, clinics or other related services, including cross-country, downhill, velodrome (track), Bicycle-motocross (BMX), trials, cyclo-cross or road cycling, which are organized, provided, arranged, conducted, sponsored, promoted orauthorized by or connected with the Releasees.
I have been advised to wear an approved helmet while participating in Cycling Activities, and to comply with all applicable municipal and provincial highway laws and regulations. I recognize that serious head injury or death can result even when a helmet is worn.
ASSUMPTION OF RISKS
I am aware that participation in Cycling Activities involves many risks, dangers and hazards including, but not limited to: changing weather conditions; mechanical failure of bicycles; falls; loss of balance; high speed descents; difficulty or inability to control one’s speed and direction; rapid or uncontrolled acceleration on hills and inclines; extreme variation in cycling terrain including steep or slippery sections, trees, roots, tree stumps, logs, cliffs, rocks, rock drops, loose gravel, holes, depressions, streams and creeks; constructed features such as bridges, ramps, ladders, bumps, berms, jumps, and drops; collisions with natural and constructed objects, other participants, vehicles, pedestrians, spectators and officials; encounters with domestic or wild animals; negligence of other persons; and NEGLIGENCE ON THE PART OF THE RELEASEES. I UNDERSTAND THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF CYCLING ACTIVITIES.
I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH CYCLING ACTIVITIES AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS
AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of the RELEASEES agreeing to my participation in Cycling Activities either as a member of Cycling BC or as a competitor, course worker, official, volunteer, event organizer, guest or member of the media, I hereby agree as follows:
- TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the RELEASEES AND TO RELEASE THE RELEASEES from any and all liability for any injury, loss, damage or expense,
including death, that I may suffer or that my next of kin may suffer, as a result of my participation in Cycling Activities, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT, R.S.B.C. 1996, c. 337 ON THE PART OF THE RELEASEES. I UNDERSTAND THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN CYCLING ACTIVITIES REFERRED TO ABOVE;
- TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES for any and all liability for any property damage, loss or personal injury to any third party resulting from my participation in Cycling Activities;
- This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity;
- This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the Province of
British Columbia and no other jurisdiction; and
- Any litigation involving the parties to this Release Agreement shall be brought solely within the Province of British Columbia and shall be within the exclusive jurisdiction of the Courts of the Province of
In entering into this Release Agreement I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of Cycling Activities, other than
what is set forth in this Release Agreement.
I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS RELEASE AGREEMENT PRIOR TO SIGNING IT, AND I AM AWARE THAT BY SIGNING THIS
RELEASE AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE
AGAINST THE RELEASEES.
Rider SIGNATURE: ___________________________________________________________
Addendum to waiver, by initialing the following and signing below, you agree with the following protocols
Re emergency protocols and injury response: Parent initial _____
Injury response. Does the rider need an ambulance? If yes call 911. If not continue with accident site first aid. Make scene safe, block trail. Decide the seriousness of the injury. Check breathing, bleeding, and for fractures. Reassure, comfort, blanket and do a transport decision. Walk/ride injured rider out, helmet must go with rider. Delegate responsibilities for continuing ride or assisting rider out. If in doubt at any time call 911! If the rider can not continue call the rider’s emergency contact.
All of our events occur where cellular service is available and our leaders carry phones. Leaders will be provided with numbers of other leaders and an emergency contact list for the kids will be available at each ride. In the rare event that a special activity takes us out of cellular service, radios will be provided. A basic first aid kit will be provided for each leader. Our first aid kits included band-aids, gauze, polysporin ointment, and a tensor bandage, in a zip lock bag. This would cover most injurys we’re going to be able to deal with on the trail.
Local Emergency Services Telephone Number: 911, 250 833 3600
Address of and directions to the nearest hospital: #601, 10st Salmon Arm, Shuswap General Hospital. Drive from South Canoe Trail parking area to highway 97B, turn right and go to highway 1, turn left. Turn right on 10st NE and park in emergency area.
Scripted safety talk protocol: Parent initial______
Skookum youth (Sprockids) Leaders are not responsible for the state of each rider’s bicycle.
It is the responsibility of rider’s parents to ensure that their bicycle is properly maintained and safe.
Don’t forget your helmet and water bottle. Dress appropriately for the weather and time of year. Ride terrain you are comfortable on, ride within your abilities. Help teach younger riders, and if you are more skilled, pass in a friendly way.
Name of rider _______________________
Name of Parent ______________________