Waiver

DYNAMIX DEVO YOUTH CYCLING DEVELOPMENT
ASSUMPTION OF RISK, WAIVER OF LIABILITY & INDEMNIFICATION,
MEDIA RELEASE FORM
(For those under 18 years old)

I, the undersigned, understand and acknowledge that participation in any activity can be hazardous and I realize that no one should enter into a recreational activity unless the participant is physically and medically able to do so. As the participant’s parent/guardian, I assume all risk associated with this activity including, but not limited to: falls, contact with other participants and/or equipment, effects of weather, equipment failure and/or condition of activity area. I fully understand that it is my responsibility to ascertain if this specific activity contains other elements of risk that could prove harmful to the participant.
Having read this waiver and in consideration of acceptance into the program, I and anyone entitled to act on my behalf do hereby release, hold harmless, and agree to indemnify Dynamix Devo, its directors, officers, agents, contractors, employees, volunteers, and servants, from and against any and all damages, or claims of damage to persons or property arising out of or related in any manner to the participant’s activities.

1. I certify that the participant does not have any medical conditions that would prevent participation in this program.

2. In case of serious emergency or illness, when the emergency contact/parent cannot be reached immediately, I hereby authorize the provider to obtain emergency medical care.

3. I grant permission to use the participant’s name, quoted material, and any photograph/ videography of the participant for the purposes of archival documentation and present/future Dynamix Devo publicity materials including newspapers, magazines, and Internet applications without compensation or consideration.
I am signing this Agreement on behalf of a minor Participant and I acknowledge that I am the Parent/Guardian of the participant and that I understand the terms of this Agreement.

Participant's Name

Parent/Guardian's Name

Parent/Guardian Agree's to the above information  yes

Date