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Belmont Library

 


Bicycle Use Authorization and Release of Liability

I, wish to use a San Mateo County Libraries (“Library”) owned bicycle, for my own personal use, for a period of seven days from the start of my reservation. I am at least 18 years old. Library is willing to authorize my use of its bicycle if I confirm and agree to the following terms: 

1.  I am sufficiently trained on use of, and familiar with, the bicycle, to safely use it. I will wear a bicycle helmet at all times while riding the Library’s bicycle.

2.  I will inspect the bicycle prior to riding; if I do not believe it is in normal operating condition, I will not use it and instead will immediately notify Library staff. I understand that Library does not warranty or guarantee the safety of the bicycle. I will exercise reasonable care during use of the bicycle. 

3.  I will use the bicycle for my own recreational purposes and will not lend it to others. 

4.  Use of the bicycle will involve risks to me of personal injury, death and damage to property. I assume all such risks. I release Library, its officers and employees, from any liability to me or my estate should my use of the bicycle result in my personal injury or death, or damage/destruction of my property; and I waive and promise not to bring any such claim or suit against Library, its officers or employees. 

5.  Use of the bicycle may involve risks to third persons, whom I might injure or kill, or whose property I might damage. I will defend, indemnify and hold Library, its officers and employee, harmless, in the event my use of the bicycle leads to a third person’s claim. 

6.  I will return the bicycle to Library at the noted time, free of damage, normal wear and tear excepted.

I FULLY CONFIRM AND AGREE TO ALL OF THE ABOVE TERMS.

LIBRARY AUTHORIZATION: Based upon her/his execution of this Use Authorization and Release form including release of liability and agreement to indemnify, the Library hereby authorizes the above signed person to use a Library bicycle for the term noted above.

April 25, 2024

First Patron's Name

First Name*

Last Name*
First Patron's Age Acknowledgment*
First Patron's Date of Birth*
I certify that I am 18 years of age or older
First Patron's Signature*
Second Patron's Name

First Name*

Last Name*
Second Patron's Date of Birth*
Third Patron's Name

First Name*

Last Name*
Third Patron's Date of Birth*
Fourth Patron's Name

First Name*

Last Name*
Fourth Patron's Date of Birth*
Fifth Patron's Name

First Name*

Last Name*
Fifth Patron's Date of Birth*
Sixth Patron's Name

First Name*

Last Name*
Sixth Patron's Date of Birth*
Seventh Patron's Name

First Name*

Last Name*
Seventh Patron's Date of Birth*
Eighth Patron's Name

First Name*

Last Name*
Eighth Patron's Date of Birth*
Ninth Patron's Name

First Name*

Last Name*
Ninth Patron's Date of Birth*
Tenth Patron's Name

First Name*

Last Name*
Tenth Patron's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
What time will you return the bike?

Please list when you will return the bike. *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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