Accident Waiver and Release of Liability Form

 

REPRESENTATION OF AUTHORITY I represent that the person completing and submitting this registration is the named participant or guest, or that I have been authorized by the named participant or guest to complete and submit this registration, that all statements and information provided herein are true and accurate, and that I have complete authority and permission to provide such statements and information. For more information on personal privacy policy please see link at the bottom of the page.

 

AGREEMENT AND RELEASE OF LIABILITY I hereby confirm that I, and anyone on whose behalf I am registering, have voluntarily chosen to participate in one or more of the activities planned and arranged by Augeo Affinity Marketing, Inc. ('Augeo') on behalf of Harley-Davidson Financial Services (‘HDFS’) during the event. I am aware that such events and activities present risks of personal injury, property loss or damage, and possible death to participants. I expressly and voluntarily assume all such risks that may result from my participation in any or all of the activities and events planned and arranged by Augeo on behalf of HDFS.

 

I hereby release Augeo and HDFS, and each of their respective employees, agents, affiliates and successors from all liability for injury, death, disability or other loss or damage resulting from my participation, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, in any or all of the events and activities planned and arranged by Augeo on behalf of HDFS in connection with the event, including but not limited to dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I will defend, indemnify and hold harmless Augeo, HDFS, and each of their respective employees, agents, affiliates and successors from all claims, judgments, and costs, including attorneys' fees, incurred in connection with any action that may be brought resulting from my participation in any subject event or activity.

 

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the Augeo, HDFS, activity holders, producers, sponsors, organizers, and assigns.

 

I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.

 

I have carefully read this agreement and release and fully understand its contents. I understand that my participation in this entire event is conditioned on, and consideration for, this release. I acknowledge that this Accident Waiverr and Release of Liability Form will be used by Augeo, HDFS, the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.  The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

 

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

 

Printed Guest Name: ___________________________________________________

Guest Signature:         ___________________________________________________

Date:                                ___________________________________________________