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WAIVER AND RELEASE OF LIABILITY – PLEASE READ BEFORE SIGNING

INHERENT RISKS OF INJURY

I understand that the risk of injury from the activities involved in this program is significant, and while skills, equipment, and personal discipline may reduce this risk, the risk of serious injury or death does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of UBFM or others, including other volunteers and the people UBFM serves, and assume full responsibility for my participation. I willingly agree to comply with all safety rules and instructions for participation, to include but not limited to, wearing a helmet and other safety equipment ALWAYS during the ride, following all instructions given by UBFM group leaders, stopping at all intersections regardless of right of way, ALWAYS staying with the group, and watching for and alerting my fellow riders to approaching vehicles as needed. If, however, I observe any unusual, significant hazard, condition or conduct that might endanger myself or others during my presence or participation, I will remove myself from participation and bring such to the attention of a UBFM representative immediately.

ASSUMPTION OF RISK

I understand that there are certain risks associated with participation in this activity. Riding bikes to deliver food with UBFM requires a certain level of fitness as it can be a vigorous activity. All riders should check with their physicians before participation, and periodically in continued participation, to determine whether they possess the fitness and health needed to safely participate. While riding on city streets, riders are likely to encounter risks including but not limited to reckless or negligent drivers; physical obstructions such as car doors suddenly opening, pedestrians, trolleys, trolley tracks, potholes, slick surfaces, and others; and unpredictable behavior and conduct of others including other volunteers and people UBFM serves and/or encounters before, during and after rides. I understand that all these risks could result in minor injuries (such as scrapes and cuts) to serious injuries (such as concussions and broken bones) to catastrophic injuries (such as paralysis, coma, or even death) and I assume these and other risks which I may encounter during my participation with UBFM. As such, I attest that I am in good health, have no health problems that preclude participation, have the skill and fitness level needed to participate safely with UBFM, and that my medical care provider has not recommended against my participation. 

RELEASE OF LIABILITY IN THE EVENT OF PROVIDER NEGLIGENCE

In consideration of my being allowed to participate with UBFM, I, for myself and on behalf of anyone who might represent me now or in the future (e.g. spouse, parents, children, heirs, assigns, administrators, personal representatives and next of kin), hereby release, indemnify, and hold harmless from any and all claims UBFM and their agents, volunteers, officers, directors, successors and assigns, the City of Memphis, and any and all sponsors, management, employees, independent contractors, insurance carriers, equipment suppliers, their representatives and successors (hereinafter referred to collectively as "Releasees"), with respect to any and all injury, disability, death, or loss or damage to person or property associated with my presence or participation, whether arising from the ordinary negligence of UBFM or Releasees or otherwise, to the fullest extent permitted by law. This release of liability extends to every phase of participation, including but not limited to, arriving on site to include parking lots, sidewalks, and facilities; preparing meals; preparing for rides; riding the chosen routes; utilizing equipment including bicycles, helmets, equipment in the kitchen, and other equipment provided by UBFM; and engaging with other volunteers and the people UBFM serves.

PERMISSION TO TREAT AND ASSUMPTION OF COSTS

I hereby authorize UBFM and Releasees to administer emergency medical care if needed including but not limited to first aid and CPR and I authorize UBFM and Releasees to seek medical care, emergency transport, and to share medical information with medical personnel if reasonably needed. I understand that I would be responsible for and I assume all costs associated with same.

INDEMNIFICATION

Additionally, in consideration of my being allowed to participate with UBFM, I hereby agree to indemnify, reimburse,defend, and hold harmless UBFM and Releasees to include legal costs, attorney fees, court costs and investigative costs related to any claims made by me and anyone else representing me now of in the future arising out of an injury to me and/or claims of co‐participants, rescuers and others arising from my conduct during my participation. I further hereby agree to indemnify and reimburse any damage caused to UBFM property including their facilities and equipment caused by my negligent, reckless or intentionally destructive conduct.

USE OF LIKENESS AND IDENTITY

I hereby release, consent to, and authorize, in advance, any such use of my name, photograph, voice or likeness by UBFM in any manner they deem appropriate without remuneration to me. 

OTHER LEGAL CONSIDERATIONS

I agree that this waiver and release shall be construed in accordance with the laws of the State of Tennessee and any action or claim shall fall within the jurisdiction and venue of Shelby County, Tennessee.  If any provision of this agreement is found to be void by any court of competent jurisdiction, I acknowledge and agree that the remaining provisions will remain in full force and effect. I hereby make a convent not to sue in the event of loss or injury but agree to submit any claim I might bring to binding arbitration. This agreement contains the entire understanding between me and UBFM and Releasees and supersedes any and all previous written or oral promises or agreements.

I HAVE CAREFULLY READ THIS WAIVER AND RELEASE; FULLY KNOW AND UNDERSTAND THE INHERENT RISKS ASSOCIATED

WITH PARTICIPATION WITH UBFM; I APPRECIATE THOSE RISKS; AND AGREE TO ASSUME RESPONSIBILITY FOR THOSE RISKS

HOLDING HARMLESS AND INDEMNIFYING UBFM AND RELEASEES DURING THIS AND ALL SUBSEQUENT PARTICIPATION. I AFFIRM THAT I UNDERSTAND THAT I AM RELINQUISHING SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT OF

FINANCIAL RECOVERY FOR INJURY, WHETHER THE INJURY RESULTS FROM THE INHERENT RISKS OF THE ACTIVITY OR FROM

THE ORDINARY NEGLIGENCE OF UBFM OR RELEASEES. DESPITE THE ABOVE, I AFFIRM THAT I AM VOLUNTARILY

PARTICIPATING IN THE ACTIVITIES WITH UBFM AND I AM VOLUNTARILY SIGNING THIS AGREEMENT WITH THE FULL

INTENT OF RELEASING UBFM AND RELEASEES OF LIABILITY FOR INJURY OR LOSS DUE TO THE INHERENT RISKS OF THE ACTIVITY OR DUE TO THE ORDINARY NEGLIGENCE OF UBFM RELEASEES. 

November 21, 2024

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*

Confirm Email*
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Participant's 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:*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) 

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her participation subject to all the terms of this waiver and release: 

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*

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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