image
Bike Arlington Heights Open Course
For Minors - Must be signed by a parent
Release & Indemnification Permission Form

Please fill out the questions below and review the Release & Indemnification form in order to participate in the Bike Arlington Heights event held on Saturday, June 20, 2015  

Please hit "Submit" when you have completed the form. 

Thank you for your participation!

WHEREAS, (Participant), as of the date of the Bike Arlington Heights event, will be under the age of 18 years old ("Child") and would like to participate Bike Arlington Heights, a recreational bike ride (“Event”)

WHEREAS, the Village of Arlington Heights, a municipal corporation, ("Village") is willing to grant permission to participate in the event,

NOW, THEREFORE, in consideration for permission to participate in this event and for other good and valuable consideration herein acknowledged, the undersigned agrees as follows:

I am the lawful parent/guardian of (Participant) and I give my child permission to participate in this event;

I understand that this course is approximately (Check one below) and that no roads are closed.  All riders must obey all traffic laws and will be crossing busy streets that are open to vehicular traffic;


I understand that there are inherent risks involved in this event; 
  
I understand and agree that if my child suffers any injuries, payment for medical care will be my responsibility; 
   
I understand and agree that despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational activity/program. Understandably, not all hazards and dangers can be foreseen. I understand that certain risks, dangers and injuries due to inclement weather, slip and falls, poor skill level or conditioning, carelessness, horseplay, unsportsmanlike conduct, premises defects, inadequate or defective equipment, inadequate supervision, instruction or officiating, and all other risks inherent to indoor and outdoor recreational activities/programs exist. I recognize that it is impossible for the Village to guarantee absolute safety; 

I hereby release and hold harmless the Village of Arlington Heights and its officers, agents, and employees from any and all liability, losses or damages, including attorneys' fees and costs of defense the Village may suffer as a result of claims, demands, suits, actions or proceedings of any kind or nature, in any way resulting from my child’s participation in this event. I will, at my own expense, appear, defend and pay all fees of attorneys and all costs and other expenses arising therefrom or incurred in connection therewith; and, if any judgments shall be rendered against the Village in any such action, I will, at my own expense, satisfy and discharge same.
 Enter information below:
Parent's Name:
Parent's Address:
Parent's Phone Number:
Parent's Email Address:
Minor's Name:
Minor's Birthdate:
Today's Date
* Indicates Response Required