Healthy Gears

Member Sign Up

Prefix

$4.17^*
per mo.

Monthly	-	$ 5.00
Quarterly	-	$ 15.00
* Yearly	-	$ 50.00

First Name

Last Name

Suffix

Sex

Male Female

Birth Date

Address

City

State

Zip Code

Email Address

WAIVER:
By signing this waiver of liability and the assumption of risk agreement, the registrant, parent/legal guardian authorizes the registrant to participate in the Healthy Gears program and acknowledges and accepts the risk inherent in the use of the program services, apparatus, facilities, activities and voluntarily and expressly assumes the risk of injury, accident, death, loss cost or damage to the registrant, to their property which might arise from the use of the program activities and the services and releases its directors, members, officers, shareholders, representatives, agents, and employees from all claims, liabilities loss, damage, costs and / or causes of action including but not limited to all bodily injuries and property damage whether or not it is contended the center, its agents, representatives or employees or their negligence contributed thereto in whole or in part, or as responsible therefore.

Signature further certifies that the participant is in good health and is able to undertake and engage in physical exercise and sports activities in which he or she chooses to participate. I acknowledge Healthy Gears' recommendation that I consult with a physician regarding the advisability of my participation in this program. Signature assumes all responsibility for updating the club of changes in physical condition and for reporting all injuries sustained while participating in the program to the ride coordinator, or safety director, and releases the company, it's directors, members, officers, shareholders, representatives, agents and employees from any liability arising out of said information.

I UNDERSTAND THAT BICYCLE HELMETS CAN PREVENT SERIOUS INJURY AND I AGREE TO WEAR ONE WHILE PARTICIPATING IN THIS PROGRAM. In addition I agree to abide by all trail regulations and traffic laws in effect at the ride location.

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I hereby attest to reading and agreeing with the
preceding waiver and accept all responsibilities.

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