Loading...

Segway PT Release Agreement

This Agreement and Release (“Agreement”) covers the use of a Segway Personal Transporter (“PT”) and related equipment which have been provided by Glide N.E.W. LLC for a trial experience.

Please read carefully and INITIAL each section:

1. I agree to use and operate the PT in accordance with the direction of the Glide N.E.W. LLC Advisor. I understand that the helmet is provided for my safety and I agree to wear the helmet when operating the PT.

2. I understand and acknowledge that operation of the PT has a significant potential for serious injury to persons, including the operator, and for loss of or damage to property, including the PT, and I assume the risk of such injury, loss, or damage. 

3. I agree to indemnify and hold Glide N.E.W. LLC harmless from and against any and all claims, demands, causes of action, suits, judgments, decrees, liabilities, obligations, injuries including death, losses, damages, costs and expenses, including attorney fees, costs and expenses incurred by Glide N.E.W. LLC with regard to such matters, for injuries of any type or kind, including death, to any person, and for loss of or damage to property of any type or kind, including the property rented to me under this Agreement, arising out of, related to, or in connection with my use and operation of the PT and the other property rented to me pursuant to this Agreement, and for my failure to fully and completely comply with the terms, provisions, and conditions of this Agreement. 

 

I have read and understand the meaning and effect of this Glide N.E.W. LLC Release Agreement and I accept the use of the PT under these terms and conditions.

Today's Date: July 3, 2020

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Pictures? We will share.
I give permission to Glide N.E.W. LLC to use any photographs or video in which I appear for promotional purposes as deemed appropriate without compensation. At the end of the tour photos will be sent to you. If you answer "No" please let your tour guide know.*
Yes
No
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver