Informed Consent and Waiver and Release
Hidden Hollow Bicycle Rodeo
This is an informed consent form for minors which identifies risks of participating in a Bicycle Rodeo and a Waiver and Release for parents and guardians. Injury may result from your participation in the Bicycle Rodeo. You are expected to familiarize yourself with the Bicycle Rodeo, what is required, and the rules of conduct for the Bicycle Rodeo. You are expected to wear appropriate safety equipment, including a helmet, and follow proper operating procedures including safety procedures as outlined by the coordinator, plus any directions given by an authorized person.
I, ______________________________, acknowledge that I have familiarized myself with the Bicycle Rodeo and what is required, will wear appropriate safety equipment, including a helmet, will follow the rules of conduct, will
follow the operating procedures, and will follow any directions given by an authorized person.
______________________________________ (Signature of Participant)
The undersigned, the legal guardian of the above identified participant, in consideration of participant’s participation in the Bicycle Rodeo, do hereby agree to this waiver and release. I recognize that participation in the Bicycle Rodeo may involve moderate to strenuous physical activity and may cause physical and/or emotional distress to participants. There may also be associated health risks. I state that participant is free from any known heart, respiratory, or other health problems that could prevent participant from safely participating in any of the activities. I certify that I have medical insurance or otherwise agree to be personally responsible for costs of any emergency or other medical care that participant receives. I agree to release Hidden Hollow Elementary, the sponsor of the Bicycle Rodeo, and their agencies, departments, officers, employees, agents, and volunteers from the cost of any medical care that participant receives or requires as a result of participation in the Bicycle Rodeo. I further agree to release Hidden Hollow Elementary, the sponsor of the Bicycle Rodeo, and their agencies, departments, officers, employees, agents, and volunteers from any and all liability, claims, demands, breach of warranty, negligence, actions, and causes of action whatsoever for any loss, claim, damage, injury, illness, attorney’s fees or harm of any kind or nature to me, participant, or participant’s heirs and assigns arising out of participant’s participation in the Bicycle Rodeo. This release extends to any claim made by parents or guardians or their assigns arising from or in any way connected with the aforementioned activities.
CONSENT
Consent is expressly given, in the event of injury, for any emergency aid, anesthesia, and/or operation if in the opinion of the attending physician such treatment is necessary.
I have carefully read and understand the contents of the foregoing language and I specifically intend to cover participant’s participation in the above stated Bicycle Rodeo.
Child’s Name: ___________________________ Teacher’s Name & Grade _______________________________
Date: __________________________________
Printed Name: ___________________________ Signature ___________________________________________
(Parent or legal guardian)