7.c Borrow A BikePage 1 of 3
WHEELS-TO-GO PROGRAM
Bike It; You’ll Like It!
ASSUMPTION OF RISK, WAIVER OF LIABILITY, AND
INDEMNIFICATION AGREEMENT (“AGREEMENT”)
IMPORTANT: THIS IS A LEGAL DOCUMENT; PLEASE READ AND
UNDERSTAND THIS DOCUMENT BEFORE SIGNING
This Agreement must be completed in order to participate in the activities associated with the LeRoy
Wheels-To-Go Program.
Participant’s Information
Note: If participant is under 18 years of age, this document must be signed ‘in person’ by parent
or legal guardian.
Name (please print): Last ____________________________ First: ___________________________
Address: __________________________________________________________________________ Street City State Zip Code
Driver’s License or Gov’t Issued ID Number: ___________________________ ID Type: _________
Phone Number: ___________________________ Email: ___________________________________
Emergency Contact Information: Name ____________________ Phone: _______________________
Second Emergency Contact: Name ____________________ Phone: _____________________
TERMS AND CONDITIONS
I, the undersigned, am the Participant named above or the Participant’s parent or legal guardian. I am familiar
with the LeRoy Wheels-To-Go Program (“Program”) and agree to take full responsibility for the Program’s
shared bicycle(s) (“Bicycles(s)”) while it is/they are under my watch. This includes adhering to all safety rules
while riding the Bicycle(s) at all times.
I understand that participation in the Program can include foreseeable and unforeseeable risks and other hazardous
activities inherent in the Program which may expose the Participant to illness, injury, or death. Participant freely
and voluntarily participates or allows participation in the Program with the knowledge of the danger involved.
As Participant, I hereby agree to assume and accept any and all risk of injury or death.
Participant’s Initial & Date: ________________________
Bike Number (s)
__________ __________
__________ __________
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WAIVER, RELEASE AND INDEMNIFICATION
Participant understands and acknowledges that the City of LeRoy/LeRoy EDA (“City/EDA”) is not an insurer of
the behavior and/or actions of the Participant, and that the City/EDA assumes no liability whatsoever for personal
injuries or property damages to the Participant, or any third party arising out of participation in the Program.
Participant hereby agrees on behalf of himself or herself to release, waive, covenant not to sue, indemnify and
hold harmless the City of LeRoy/LeRoy EDA, and all of their officers, employees, agents, and volunteers
(collectively the “Releasees”) from any and all liability including any liability or claims perceived to be caused
by COVID-19, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss,
damage, or injury, including death, that may be sustained by Participant or loss or damage to any property
belonging to the Participant, or any third party arising out of or related to participation in the Program.
Participant does not have any medical conditions that would prevent participation in above named Program.
Furthermore, Participant has adequate health insurance to cover the costs of treatment in the event of any injury.
Participant, on behalf of himself or herself, agrees that this Agreement will be governed by and construed in
accordance with the laws of the State of Minnesota, without application of any principles or choice of law. In the
event that a lawsuit arises between the Participant and the City/EDA, Participant shall pay any attorney fees or
costs incurred by the City/EDA in enforcing this Agreement. If any portion of this Agreement is held to be invalid
by a court of law, then it is agreed and intended that all the remainder shall, notwithstanding, continue in full force
and effect.
PARTICIPANT HAS CAREFULLY READ THESE TERMS AND FULLY UNDERSTANDS THEIR
CONTENT AND IS AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN
THE PARTICIPANT AND THE RELEASEES AND SIGNS IT AT HIS OR HER OWN FREE WILL.
Participant freely and voluntarily assumes the risks of using the Equipment. He/she acknowledges that he/she
has executed this Contract and Release in order to use the Equipment. For Participants who are minors, the adult
signing on his/her behalf represents and warrants to the City/EDA that he/she is the legal guardian of that minor
and possesses full legal authority to release and waive claims, and to covenant not to sue, on that minor’s behalf.
The undersigned has read this Contract and Release in its entirety.
Le Roy Wheels-To-Go Program recommends that all Participants wear a helmet and seek instruction
from a staff volunteer in the safe operation of the equipment. Helmets are provided free to Participants.
Helmets – Each Participant or his/her guardian must mark his/her choice below: YES-I will wear a safety
helmet. NO-I refuse to wear any type of safety helmet and accept full responsibility for this decision.
_____ YES _____ NO
_____________________________ ____________________________________________________________
Name of Participant Signature of Participant (or legal guardian if a minor) Date
Participant’s Initial & Date: _______________________
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SEASON PASS: Parent or legal guardian authorizes minor to participate in LeRoy Wheels-To-Go
Program for the entire ______ season.
________________________________ _____________________________________________________
Name of Participant Signature of Participant (or legal guardian if a minor) Date
“WHEEL’S TO GO” BIKE PROGRAM
Bike
No.
Date Time
Out
Estimate
Return
Time
In
Name Comments