DETROIT-METRO REGIONAL CONSORTIUM MOTORCYCLE
SAFETY COURSE WAIVER & INDEMNIFICATION
Participation in this course requires physical stamina, motor
coordination, and mental alertness. The
undersigned hereby attests that he/she has no known physical or mental
limitations and has not used any form of alcohol, prescription or
non-prescription drugs that could impair his/her performance in this course.
Participants under 18 years of age must have this form signed by a
parent or guardian.
Participant must be a legal resident of the State of
NAME:
__________________________________________________________________________________________________________
PRINT CLEARLY (First)
(Middle)
(Last)
ADDRESS:__________________________________________________________________________________________________
City
State Zip Code
PHONE: ( ___________ )
______________________________ DATE OF BIRTH:
______________________ AGE: _______
DRIVER LICENSE NUMBER: _______________________________________________ STATE
OF: ______________
I. READ
CAREFULLY: THIS SECTION IS A LEGAL
RELEASE, ASSUMPTION OF RISK, WAIVER AND COVENANT NOT TO SUE AGREEMENT
In consideration of
SCHOOLCRAFT COLLEGE, the MOTORCYCLE SAFETY FOUNDATION, and the CIRCLED TRAINING SITE BELOW including
their members, employees, officers and/or agents (the “Safety Course
Providers”), furnishing services, equipment, and/or curriculum to enable me to
participate in the Motorcycle Safety Course, I agree as follows:
WAYNE COUNTY COMMUNITY COLLEGE DISTRICT
I fully understand and acknowledge that: (a) there are DANGERS AND RISK OF INJURY, DAMAGE, OR DEATH that exist in my use
of motorcycles and motorcycle equipment and my participation in the Motorcycle
Safety Course activities; (b) my participation in such activities and/or use of
such equipment may result in injury or illness including, but not limited to, BODILY
INJURY, DISEASE, STRAINS, FRACTURES, PARTIAL AND/OR TOTAL PARALYSIS, OTHER
AILMENTS THAT COULD CAUSE SERIOUS DISABILITY, OR DEATH; (c) these risks and
dangers may be caused by the negligence of the Safety Course Providers; the
negligence of others, including other Safety Course participants; and may arise
from foreseeable or unforeseeable causes; and (d) by participating in these
activities and/or using the equipment,
I, on behalf of myself, my personal representatives and my heirs, hereby assume
all risks and all responsibility, and agree to release the Safety Course
Providers for any injuries, losses and/or damages, including those caused
solely or in part by the negligence of the Safety Course Providers, or any
other person. If I have brought a
motorcycle to use in the Safety Course, I also agree that this release applies
to any damage that occurs to it during the Safety Course.
I agree and understand that, on behalf of
myself, my personal representatives and my heirs, I am relinquishing any and
all rights I now have or may have in the future to sue the Safety Course
Providers for any and all injury, damage, or death I may suffer arising from
motorcycle riding or its equipment, including claims based on the Safety Course
Providers’ negligence.
I HAVE READ THIS
RELEASE AGREEMENT AND BY SIGNING BELOW I AGREE IT IS MY INTENTION TO ASSUME ALL
RISKS AND RELEASE SAFETY COURSE
PROVIDERS FROM LIABILITY FOR PERSONAL
INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER
CAUSE. I have had the opportunity to
ask any questions about the above waiver and release and I understand its terms
and meaning.
____________________________________________
_____________________________________________ (Participant Name – Please Print) (Participant
Signature)
______________________
_____________________________________________________ ________________________________
(Date) (Signature of parent or legal guardian if
less than 18 years old) (Relationship)
II. READ CAREFULLY: THIS SECTION IS AN INDEMNIFICATION AND HOLD
HARMLESS AGREEMENT
In consideration of SCHOOLCRAFT COLLEGE,
the MOTORCYCLE SAFETY FOUNDATION, and the CIRCLED TRAINING SITE BELOW including
their members, employees, officers and/or agents (the “Safety Course
Providers”), furnishing services, equipment, and/or curriculum to enable me to
participate in the Motorcycle Safety Course, I agree as follows:
HENRY FORD COMMUNITY COLLEGE
MACOMB
COMMUNITY COLLEGE MONROE COMMUNITY COLLEGE
OAKLAND
COMMUNITY COLLEGE ST. CLAIR COUNTY COMMUNITY COLLEGE
WAYNE
COUNTY COMMUNITY COLLEGE DISTRICT
I, on behalf of myself, my
personal representatives and my heirs, agree to hold harmless, defend, and
indemnify the Safety Course Providers from any and all claims, suits, or causes
of action by others for bodily injury, property
damage, or other damages which may arise out
of my use of motorcycles and motorcycle equipment or my participation in the
Motorcycle Safety Course activities, including claims arising from the Safety
Course Providers’ or any other party’s negligence.
I HAVE READ THIS INDEMNIFICATION AND HOLD HARMLESS
AGREEMENT AND BY SIGNING I AGREE IT IS MY INTENTION TO ACCEPT LEGAL
RESPONSIBILITY AND PAY FOR ANY LOSS FOR CLAIMS OR LAWSUITS AGAINST SAFETY COURSE PROVIDERS ARISING FROM MY PARTICIPATION
IN THE MOTORCYCLE SAFETY COURSE. I have had the opportunity to
ask any questions about the indemnification and hold harmless section and I
understand its terms and meaning.
___________________________________________
_____________________________________________ (Participant Name – Please Print) (Participant
Signature)
______________________
_____________________________________________________ ________________________________
(Date) (Signature of parent or legal guardian if
less than 18 years old) (Relationship)