Event Waiver Form

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About You: Complete this section in its entirety.

 

Last Name: ___________________________  First Name: ______________________________
Preferred Name/Nickname: _______________________________________________________
Home Address: ___________________________________________ Apt: _______________
City: _______________________________________ State: __________ Zip: _____________
Home Phone: (_____)_______-___________            Cell Phone: (_____)______-________­­___
Birth Date: ____/____/______  email address: _______________________________________
  PGR Member Participant     Non-Member Participant
Emergency Contact Name: ________________________ Phone: (_____)_______-___________
About your bike:  Complete this section if you will be riding a motorcycle in this event. Cross it out if you will be a passenger.
Make: _______________________ Model: _____________________ Displacement: _________
About the lawyers: Check the box alongside the appropriate statement below, draw a large "X" through the statement that does not apply to you, and sign and date BOTH sections. If you will not be operating a motorcycle, also put a large "X" through the "About your bike" section above.
"I, the undersigned, certify that the motorcycle listed above is legally registered in accordance with state, city, and/or local licensing and registration requirements. I further certify that I carry property and liability insurance for myself, my passengers, and the motorcycle which meets at least the minimum state, city, and/or local insurance requirements. I also certify that I carry a valid driver's license with either a cycle endorsement or a valid Motorcyclist Temporary Instruction Permit in accordance with state, city, and/or local laws. I further certify that I have the legal right to utilize the listed motorcycle. I accept full responsibility for my safety and conduct, and the safety and conduct of any who may be participating as my guest or passenger in this event. I realize that these are requirements for my participation in this event. "

 

 "I am participating as a passenger of the following participant:  ____________________________________________________, who has certified their compliance with requirements of the event via a separate waiver form.  I will not be operating a motorcycle during this event, but am participating in this event as a passenger. "
ADMINISTRATIVE NOTE: Attach this form to the associated motorcycle operator’s waiver form upon completion.

 

Signed: ___________________________________ Date: ___________________

 

"I, the undersigned, agree that the PGR, and the PGR (henceforth referred to as 'The Patriot Guard' or simply as 'Riders'), shall not be liable or responsible for damage to property or injury to persons including myself during this event, even where the damage or injury is caused by negligence (except willful neglect). I understand and agree that participation in this event is voluntarily, and is at my own risk. I release and hold the Riders officers and the PGR harmless for any injury loss to my person or property that may result through my participation in this event. I understand that this means that I agree not to sue the Riders officers, whether local, state or national, nor the PGR for any injury resulting to myself or my property in connection with this event."

 

Signed: ___________________________________ Date: ___________________