Calfee Design
783 San Andreas Road
La Selva Beach, CA 95076
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Click (or tab) in each field and type in your information, then print the form using your
computer's print command. After the form is printed sign all areas indicated. Mail all completed
pages and your check to:
Calfee Design |
ACCIDENT WAIVER AND RELEASE OF LIABILITY
I acknowledge that this athletic event is an extreme test of a
person's physical and mental limits and carries with it the potential
for death, serious injury and property loss. The risks include, but are
not limited to, those caused by terrain, facilities, temperature,
weather, condition of athletes, equipment, vehicular traffic, actions
of other people including, but not limited to, participants,
volunteers, spectators, coaches, event officials, and event monitors,
and/or producers of the event, and lack of hydration. These risks are
not only inherent to athletics, but are also present for volunteers. I
hereby assume all of the risks of participating &/or volunteering
in this event. I realize that liability may arise from negligence or
carelessness on the part of the persons or entities being released,
from dangerous or defective equipment or property owned, maintained or
controlled by them or because of their possible liability without
fault.
I certify that I am physically fit, have sufficiently trained
for participation in the event and have not been advised otherwise by a
qualified medical person.
I acknowledge that this Accident Waiver and Release of
Liability (AWRL) form will be used by the event holders, sponsors and
organizers, in which I may participate and that it will govern my
actions and responsibilities at said events.
In consideration of my application and permitting me to
participate in this event, I hereby take action for myself, my
executors, administrators, heirs, next of kin, successors, and assigns
as follows: (A) Waive, Release and Discharge from any and all liability
for my death, disability, personal injury, property damage, property
theft or actions of any kind which may hereafter accrue to me or my
traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS:
Calfee Design, LLC, their
directors, officers, employees, volunteers, representatives, and
agents, the event holders, event sponsors, event directors, event
volunteers; (B) Indemnify and Hold Harmless the entities or persons
mentioned in this paragraph from any and all liabilities or claims made
by other individuals or entitles as a result of any of my actions
during this event.
I hereby consent to receive medical treatment which may be
deemed advisable in the event of injury, accident and or illness during
this event.
I understand that at this event or related activities, I may
be photographed. I agree to allow my photo, video or film likeness to
be used for any legitimate purpose by the event holders, producers,
sponsors, organizers and or assigns.
This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I hereby certify that I have read this document and I understand its content.
PARENT GUARDIAN WAIVER FOR MINORS (Under 18 years old)
The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
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KEEP THIS MEDICAL RELEASE FORM
Medical Authorization and Consent to Minor Rider Pursuant to California Civil Code, Section 25.8
Minor to carry on the day of the ride.
DO NOT MAIL!
| Name of minor | Birth date | Blood type if known |
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The undersigned does hereby authorize or such substitute as he may designate, as agent for the undersigned to consent to any X-ray examination, anesthetic, medical, dental, or surgical treatment, and hospital care for the above minor, which is deemed advisable by and to be rendered under the general or specific supervision of any physician and surgeon, licensed under the Provision of Medicine Practice Act, and/or Dentist licensed under the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital or elsewhere. This authorization will remain effective while the above minor is in route to and from, involved or participating in Cyclists for Cultural Exchange Strawberry Fields Forever events, unless revoked in writing by the undersigned and delivered to the aforesaid agent.
| Parent or guardian signature___________________________ Date / / |
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Address Phone - - |