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FCBA Silver Comet

Participants Full Waiver, Release, Warranty and Agreement

 

FORMAL RELEASE OF ANY AND ALL LIABILITY

I fully assume all risks associated with my participation in the event. Further, I fully release and discharge without l imitation The Fuller Center for Housing, Inc. and their employees, directors, agents, volunteers, officers, co-ventures, and partners (“FCH”) from any and all actions, claims, or demands for damages or any other form of relief of any type, whether known or unknown, present or future, and regardless of the legal theory or claim for relief, that in any respect arise from or in any way connect with my participation in any Fuller Center Bicycle Adventure event(s) (“FCBA” or “Event”). The foregoing release and discharge is binding upon me personally, my agents, any sponsors, assigns, my medical providers, heirs, executors/administrators, family members and any person or entity with any form of interest in my estate. I covenant not to bring any form of claim or action against FCH or FCBA for a matter having any form of connection with the Event. I further specifically release FCH and FCBA for any acts of negligence in connection with the Event. I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the States of your home state and Georgia, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Georgia.

I understand that my participation in the FCBA is a potentially hazardous activity that can result in serious bodily injury, including permanent disability, paralysis, and death from a wide variety of matters that may arise in connection with the Event, known and unknown, predictable and unpredictable, and that injury and illness can result to me and others from matters in connection with the Event that are not normally deemed to be potentially dangerous activities.

I agree to wear a helmet at all times and use reflective mirrors or lights or other visual-enhancement during darker hours while cycling during the FCBA.

I understand that FCH reserves the unlimited right in its sole discretion to deny or cease my participation in a FCBA event at any time before or during the trip. In exercising its unlimited discretion to refuse or cease participation, FCH will consider the following grounds: inaccurate or incomplete applications; failure to meet the fundraising requirements or deadlines; skills, physical or medical conditions that may affect effective participation; violation of any FCH and FCBA conduct policy; disrespect shown to the leaders of the FCBA; behavior deemed by FCBA in its sole discretion to be dangerous or detrimental to myself or other participants or any other way detrimental to the best interests of FCH, FCBA and the event. I further understand that in the case of my withdrawal or expulsion from the trip, my fundraising balance and registration fee will be considered a donation to FCH and will not be refunded.

I agree that I will not participate in the FCBA unless I am medically able to do so and unless I am properly trained.

I warrant to FCH and FCBA that I am medically able, and properly trained, that I know how to perform basic skills in participating in the Event (including but not limited to, operating bicycle gears, brakes, seat adjustments, quick releases, performing repairs to my bicycle in the event of damage that may occur during the Event, the rules of the road, and proper bicycle etiquette). I warrant that I am aware of and assume all risk associated with bicycling, including but not limited to injuries or death related to falling, collision, psychological issues, slick pavement, broken traffic laws, road debris, actions or lack of action by other cyclists or motorists, personal inexperience or ability, improper or inaccurate instructions from trip leaders, and other risks or causes of injury. I accept the risk that other Event participants and FCH or FCBA actors may not have some skills or knowledge and that I can be injured as a result. I understand that the FCBA does not certify that the provided bicycling routes include roads suitable for bicycling, and that the decision to bicycle on those roads is my own.

I understand that the FCBA is not just a bicycling event, but there are other risks that might be associated with my participation, including but not limited to risks related to volunteer work projects with FCH or its partner organizations, improperly cooked food, injury resulting from cooking or from being in proximity with others cooking, driving or being driven in motor vehicles, loss or accidental sharing of medical information, and burns from grills or open fires. I assume and am responsible for all risk, as set forth above, associated with the FCBA.

I understand that I need to have my own health insurance while on the trip. I further agree to undergo any needed or recommended medical treatment in the event of accident, illness or medical or other condition during a FCBA event. It is my responsibility to inform FCH of any changes in my medical condition before the tour begins. Failure to meet any of the above conditions may result in my dismissal from the trip.

In addition, I hereby grant and convey unto FCH and the Event all right, titles, and interest in any writing, picture, or audio/video recording made by or in connection with FCH or the Event, to be used as the Event and FCH sees fit, including but not limited to any royalties, proceeds, or other benefits derived from such writings, pictures, or recordings.

I understand that The Fuller Center for Housing, Inc. (“FCH”) reserves the right to restrict my participation if deemed to be unsafe or medically inappropriate, but that FCH is not responsible for determining whether or not I am fit to participate. I warrant that I am medically able to participate in the Fuller Center Bicycle Adventure and that I am unaware of any medical condition that could potentially limit my participation. I agree that I will not participate unless I am medically able to do so, and I understand that the responsibility for determining whether I am in condition to participate falls upon me, not FCH. I further agree to undergo any prescribed medical treatment in the event of accident or illness during an event of FCH.

I also understand that it is my obligation and responsibility to have a physical examination if needed to determine if I have any medical condition that might potentially limit my participation, and that it is not the responsibility or obligation of FCH to verify my medical condition. It is my responsibility to inform FCH of any changes in my medical condition. Failure to meet any of the above conditions may result in my dismissal from the Fuller Center Bicycle Adventure.

I consent to allow the use of an electronic signature and electronic transmission of this agreement. I agrees not to deny the legal effect or enforceability of this agreement solely because it is in electronic form or was transmitted electronically or because it is not in its original form as an original document.

I have read, understand, and agree to the above statement.

I HAVE CAREFULLY READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE VOLUNTARILY AND WITHOUT DURESS GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO IT AND HAVE AGREED TO IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

I WARRANT I AM NOT UNDER THE INFLUENCE OF ANY IMPAIRING SUBSTANCE WHILE SIGNING THIS AGREEMENT AND THAT I WILL NOT USE OR CONSUME ANY IMPAIRING SUBSTANCE DURING THE EVENT.

First Participant's Name

First Name*

Middle Name

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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