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Please Fill out this Waiver every group ride

 

 

In the last 14 days, I have not had any of the following COVID-19 symptoms. If at any point upon attending this Group Ride you begin experiencing any of the below symptoms, you are required to notify a Rebound Cycle representative immediately. 

  • Fever 
  • Cough
  • Shortness of Breath
  • Sore Throat 
  • Runny Nose or Nasal congestion
  • Feeling unwell or fatigued
  • Pneumonia (infection of the lungs)
  • Nausea/vomiting/diarrhea

I Agree

In the last 14 days, you or anyone in your household has not 

  • Travelled out of country?
  • Been in contact with a person who traveled out of country?
  • Been diagnosed with COVID-19?
  • Have close contact with a person who has a probable or confirmed case of COVID-19

I Agree

If you are experiencing any of the above symptoms, or have any health concerns, please do not attend the Rebound Cycle Group Ride, connect with one of our staff or ambassadors to notify them, and call your family Doctor.

By clicking I agree below, I hereby certify that I have accurately and correctly answered the questions above to the best of my knowledge and consent to the collection, use, and disclosure of my personal information for the purpose disclosed herein. I acknowledge that my responses to this questionnaire may affect my ability to attend this group ride. By clicking I agree below, and in consideration of being allowed to attend this group ride, I hereby acknowledge that attending public gatherings such as this session may increase my risk of exposure to COVID-19, I assume, without limitation, the risk associated with my voluntary attendance and participation in this group ride and I, for myself, my estate, successors and assigns, release, indemnify and hold harmless Rebound Cycle and its owners, managers, members, employees, volunteers, participants, representatives and agents from any injury, personal injury, damage, expense, loss of income, or loss of any kind that I may suffer arising out of my attendance and participation in this group ride in relation to COVID-19, including, but in no way limiting the generality of the foregoing, as a result of the negligence of Rebound Cycle

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*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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.


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