Waivers | Yonkers Bike Club

Waiver and Release Form

Please complete, sign and submit this form to participate.

First name

Last name

Date of Birth

Have you beenhospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness, or injury?

Yes

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Please elaborate on anything we should know about your health.

I declare that the info I’ve provided is accurate & complete

I, in consideration of being permitted to participate in the Tour de Yonkers, on behalf of myself and my spouse, domestic partner, heirs, estate, executors, administrators, successors, and assigns, hereby affirm: I understand and acknowledge the nature and dangers of bicycling which involves the risk of injury, serious or disabling, or death and personal and property injury and damage. I understand that it is my personal responsibility to consult with my doctor regarding my participation in this event and I represent that I do not have any medical conditions which would prevent me from taking part in bicycling activities, including the Tour de Yonkers, and that I am physically fit to participate in this event. I assume full responsibility for the risks of bodily injury, death, or property damage that I may sustain as a result of my participation in this event, whether caused by the negligence of releasees or otherwise, and for any losses, costs, and damages I incur as a result of my participation in this event. I irrevocably release, waive, and discharge from any and all liability, and covenant not to sue, the Yonkers Bike Club, its officers, agents, members, successors, and assigns (“releasees”), for or on account of any bodily injury, loss or damage, and any claim(s) or demand(s) therefore, associated with my participation in this event. I affirm that I have read this Waiver and Release and I understand its contents. I am aware that this is a binding document and I sign it of my own free will. I further acknowledge that no oral representations, statements, or inducements apart from the foregoing writing have been made.

Type your name to sign the waiver and release form

Thanks for submitting this waiver form!