Loading...

Release of Liability 

7 Deo Volente Complex, Sabie st, Bloemhof, Cape Town,7530

rob.rubbersidedown1@gmail.com /  0815590282

Rubber Side Down Rides and Skills



Rubber Side Down Waiver

I, the undersigned agree, that I have voluntarily requested to participate in the Rubber Side Down MTB Skills Clinic.

I AM AWARE THAT THE SKILLS CLINIC WILL INCLUDE DEMONSTRATION OF MOUNTAIN BIKE SKILLS AND TECHNIQUES SUCH AS CORNERING, BRAKING, JUMPING, AND OTHER PHYSICALLY STRENEOUS MOVEMENTS REQUIRED TO CONTROL A MOUNTAIN BIKE ON NATURAL SURFACE TRAILS AND MAN-MADE FEATURES/OBSTACLES. I AM AWARE THAT I COULD BE SERIOUSLY INJURED OR EVEN KILLED IN THE EVENT OF A CRASH. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKOWN.

WAIVER: In consideration of permission to participate in the RUBBER SIDE DOWN Clinic I , on behalf of myself, my heirs, personal representatives, or assigns, DO HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE RUBBER SIDE DOWN, its directors, officers, employees, volunteers, independent contractors, and agents from liability FROM ANY AND ALL CLAIMS ARISING FROM THE ORDINARY NEGLIGENCE OF RUBBER SIDE DOWN or any of the aforementioned parties as part of RUBBER SIDE DOWN. This agreement applies to 1) personally injury (including death) from accidents or illnesses arising from participation in the RUBBER SIDE DOWN Mountain Bike Skills Clinic and 2) and all claims resulting from damage to, loss of, or theft of personal property.

ASSUMPTION OF RISK: Mountain biking, by its nature, carries with it inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. RUBBER SIDE DOWN involves the demonstration of mountain biking skills and techniques that require quick movements involving speed and change of direction, exertions of strength, and can involve stress on the cardiovascular system. RUBBER SIDE DOWN will also involve other participants, which present hazards associated with multiple users in a defined space.

The specific risks involved in mountain biking can range from 1) minor injuries such as scratches, bruises, and sprains to 2) major injuries such as concussions, broken bones and heart attacks 3) catastrophic injuries including paralysis and death.

I AGREE TO FOLLOW ALL POSTED AND/OR ANNOUNCED SAFETY RULES, AND ALL RULES COMMON TO MOUNTAIN BIKING. I agree to report any unsafe practices, conditions, or equipment to the event management.

MEDICAL HISTORY: I certify that 1) I possess a sufficient degree of physical fitness to safely participate in the RUBBER SIDE DOWN Mountain Bike Skills Clinic, 2) I understand that I am to discontinue any activity at any time I feel undue discomfort or stress, and 3) I will indicate below any health related conditions that might affect my ability to safely and I will verbally inform the instructors or management immediately.

EMERGENCY MEDICAL CARE: In the event of a medical emergency, I authorize and give my consent and permission to RUBBER SIDE DOWN to provide any and all medical assistance, including but not limited to first aid, arranging treatment by medical personnel, physicians, nurses, or paramedics, and to authorize any emergency medical treatment. I further understand that in the event of a medical emergency that I WILL BE FINANCIALLY RESPONSIBLE FOR ANY EXPENSES INVOKED.

INSURANCE: I understand that I am solely responsible for any medical, health, or personal injury costs relating to my participation in the RUBBER SIDE DOWN Mountain Bike Skills Clinic. I understand that I am strongly encouraged to have a physical examination and purchase health insurance prior to any and all participation in the RUBBER SIDE DOWN Mountain Bike Skills Clinic.

INDEMNIFICATION AND HOLD HARMLESS: I also agree to HOLD HARMLESS AND INDEMNIFY RUBBER SIDE DOWN from all claims resulting from my negligence and to reimburse them for any expenses incurred as a result of my involvement at the RUBBER SIDE DOWN Mountain Bike Skills clinic. I further agree to pay all costs and attorney’s fees incurred by RUBBER SIDE DOWN in investigating and defending a claim or suit if my claim is withdrawn, or to the extent a court or arbitration determines that RUBBER SIDE DOWN is not responsible for the injury or loss.

I have read the previous paragraphs and I KNOW THE NATURE OF THE ACTIVITIES at the RUBBER SIDE DOWN Mountain Bike Skills Clinic. I UNDERSTAND THE DEMANDS of those activities relative to my physical condition and skill level, and I APPRECIATE THE TYPES OF INJURIES that may occur as a result of activities made possible by RUBBER SIDE DOWN. I HEREBY ASSERT THAT MY PARTICIPATION IS VOLUNTARY AND THAT I KNOWINGLY ASSUME ALL SUCH RISKS.

ACKNOWLEDGMENT OF UNDERSTANDING:I HAVE READ THIS WAIVER of liability and indemnification agreement and fully understand its terms. I UNDERSTAND THAT BY SELECTING ACCEPT ON THE ONLINE FORM THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY RIGHT TO SUE. I acknowledge that I am accepting this agreement freely and voluntarily, AND INTEND MY ACCEPTANCE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's information

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Third Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Fourth Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Fifth Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Sixth Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Seventh Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Eighth Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Ninth Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Tenth Participant's Name

First Name*

Middle Name

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

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
Minor's Information

Do you have any medical conditions, injuries or allergies we need to be aware of?
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact Name *

Emergency Contact Number
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 information

ID Number
May we use pictures and media taken of you or your child during our lessons for social media and marketing purposes?*
No
Yes

Do you have any medical conditions, injuries or allergies we need to be aware of?
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 - TRY IT FREE!