Portuguese Sporting Club

               Perth Amboy, New Jersey

Via Pal  

D/B/A Champion Ride

Release and waiver of liability, assumption of risk, Indemnity, And Parental consent Agreement ("Agreement ") for Via Pal d/b/a Champion Ride("Via Pal").

In consideration of being permitted to participate in any way in Via Pal d/b/a Champion Ride ("Via Pal") sponsored Bicycling Activities ("Activities") I, for my personal representatives, assigns, heirs, and next of kin:

1. Acknowledge, agree, and represent that I understand the nature of bicycling Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if, at any time I believe conditions to be unsafe, I will immediately discontinue further participation in Activity.  Helmet Must..

2. Fully understand that (a) bicycling activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis and death ("risks");(b) these risks and dangers may be cause by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which the Activity takes place, or THE negligence of the "releases" name below; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I may incur as a result of my participation or that the minor in the Activity.

3.Hereby release, discharge, and covenant not to sue, Via Pal d/b/a, Champion Ride jurisdictional agencies where the event occurs, its respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity takes place, (each considered one of the "RELEASEES" herein) From all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the "releases"  or otherwise, including negligent rescue operations. And i further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify, save and hold harmless each of the releases from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

I am 18 YEARS OF AGE OR OLDER, I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT, UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGRREMENT, HAVE SIGNED IT VOLUNTARILY AND WHITHOUT 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. I AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

Adult____________________________________________Date____________ t-shirt Size______

I have read this release (Initial above line) _______________________________

Participant's Name (Print above line                               Participant's signature (only if  18 or over)

Email ________________________________

Emergency contact (name and number) _____________________________________________________


Portuguese Sporting Club of Perth Amboy

782 State Street, Perth Amboy, NJ 08861   |   (732) 826-2288  |  psc@portuguesesportingclub.com

"Portuguese Sporting Club" is a 501(c)4 non-profit organization.

Powered by Wild Apricot Membership Software