Release from Responsibility, Assumption of Risk, and Waiver
UMKC Clean Commute- Semester Bicycle Checkout
Swinney Recreation Center
5030 Holmes Kansas City, Missouri 64110
(816) 235-1772
www.umkc.edu/src
I acknowledge that by signing this document, I am assuming risks and
agreeing to indemnify, not to sue and release from liability The Curators of
the University of Missouri, its associates and their respective agents,
employees, volunteers and affiliates, and that I am giving up substantial
legal rights. This release is a contract with legal and binding consequences
and it applies to all activities of the UMKC Clean Commute Program
regardless whether or not listed above. I have read it carefully before
signing and I understand what it means and what I am agreeing to by
signing. I hereby freely agree to and make the following contractual
representations and agreements: I acknowledge that cycling is an inherently
dangerous sport and fully realize the dangers of participating in this
program, whether as a rider, volunteer, or otherwise, and I fully assume the
risks associated with such participation including, by way of example, and
not limitation: dangers associated with manmade and natural jumps the
dangers of collision with pedestrians, vehicles, other riders, and fixed or
moving objects the dangers arising from surface hazards, including
potholes, equipment failure, inadequate safety equipment, use of
equipment or materials provided by the Clean Commute Program and
others, the releases’ own negligence, the negligence of others and weather
conditions and the possibility of serious physical and/or mental trauma or
injury, or death associated with the UMKC Clean Commute Program.
I agree it is my sole responsibility to be familiar with the Releasees’
rules, and any special regulations and agree to comply with all such rules
and regulations. I understand and agree that situations may arise during
the UMKC Clean Commute program which may be beyond the control of
the Releasees, and I must continually ride and otherwise participate so as
to neither endanger myself nor others.
For myself, my heirs, executors, administrators, legal representatives,
assignees, and successors in interest (collectively “Successors”) I hereby
waive, release, discharge, hold harmless and promise to indemnify and not
to sue the releases and all sponsors, organizers and promoting
organizations, property owners, law enforcement agencies, public entities,
special districts and properties that are in any manner connected with this
program, and their respective agents, officials, and employees through or
by which the event will be held, (the foregoing are also collectively deemed
to be releases), from any and all rights and claims including claims arising
from the Releasees’ own negligence, which I have or which may hereafter
accrue to me and from any and all damages which may be sustained by me
directly or indirectly in connection with, or arising out of, my participation in
or association with the UMKC Clean Commute program.
This contract may not be modified orally, and a waiver or
modification of any provision shall not be construed as a waiver or
modification of any other provision herein or as consent to any
subsequent waiver or modification.
I accept responsibility for the condition and adequacy of my
equipment, any equipment provided for my use, and my conduct in
connection with this program. I will wear a helmet which satisfies the
certification requirements and that can protect against serious head
injury, and assume all responsibility and liability for the selection of such a
helmet. I have no physical or medical condition which would endanger
myself or others if I participate in this program, or would interfere with
my ability to safely participate in this program.
I agree, for myself and my Successors, that the above
representations are contractually binding, and are not mere recitals, and
that should I or my Successors assert a claim contrary to what I have
agreed to in this contract, the claiming party shall be liable for the
expenses (including legal fees) incurred by the releases in defending the
claims.
I consent to the release by any third party to Releasees and their
insurance carriers of my name and medical information that may relate
solely to any injury or death I may suffer arising from the program. Every
term and provision of this contract is intended to be severable. If any one
or more of them is found to be unenforceable or invalid, that shall not
affect the other terms and provisions, which shall remain binding and
enforceable.
I HAVE READ, UNDERSTOOD AND AGREE TO THE PROVISIONS OF
THIS DOCUMENT ON THE
DAY OF
, 20
.
(continued above on the right)
SIGNATURE
Name
Student/Employee ID#
Address
City
Email
DOB
Mobile
Home
Emergency Contact
Equipment Checked Out UMKC/Clean Commute Bike#
UMKC Affiliation
State
Zip Code
UMKC Student / Benefit Eligible Faculty or Staff
(circle one)
Phone
Lock & Key #
Helmet #
Thank you for choosing Swinney Recreation Center’s Clean Commute program.
Please ride safely.
1/2014
University of Missouri – Kansas City (UMKC)
Swinney Recreation Center (SRC) Clean Commute Program
Agreement of Understanding
I. Membership Information and Guidelines
1.
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4.
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6.
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11.
Because of the dangers inherent to riding a bicycle, it is important to follow all city, state and federal laws and
regulations regarding the operation of bicycles. In addition, use of a helmet is required at all times during operation of
the bicycles used in the UMKC/SRC Clean Commute program.
The attached waiver is in effect at any time a bicycle is loaned out from the UMKC/SRC Clean Commute Program.
It is imperative not to use alcohol or any other intoxicants while operating a bicycle as it will impair judgment and motor
skills as well as increasing the risk of accident and/or injury.
UMKC/SRC Clean Commute bicycles must be ridden only by the member who has lawfully checked out the bicycle.
A security deposit in the form of University account information is required to participate in the UMKC/SRC Clean
Commute Program. Should a Clean Commute bicycle and included accessories not be returned, the member’s University
account will be charged an amount equal to the value of a new replacement bicycle.
If the UMKC/SRC Clean Commute bicycle is ridden after dark, member must exercise additional care and utilize the light
attached to the bicycle. Addition precautions, such as wearing brightly colored clothing and reflectors, should be utilized
in order to be more easily visible to automobile drivers.
Bicycles must be securely locked when not in use. Always lock through the frame, and, when possible, through one wheel
as this better prevents the bicycle from tipping over as well as makes the bicycle more difficult to steal. Should a Clean
Commute bicycle become damaged or stolen, it is imperative to contact Swinney Recreation Center immediately.
UMKC/SRC Clean Commute reserves the right to deduct penalty fines from the member’s deposit should the bicycle not
be returned in fair condition.
Bicycles will be loaned out for one (1) semester at a time. It is the responsibility of the member to return the bicycle to
UMKC/SRC Clean Commute within three (3) days following the end of the academic semester. Clean Commute bicycles
will not be available to members for any two (2) consecutive semesters.
Members will provide their own Consumer Product Safety Commission-certified safety helmet and attend required
safety trainings.
Success of this program depends upon member participation. Therefore, members will attend periodic group meetings
and track usage of the bicycles. In addition, UMKC/SRC Clean Commute requests that members volunteer for a total of
five (5) hours within the Clean Commute program over the course of the semester.
II. Documentation (Check all that apply)
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Passport
Driver’s License
UMKC OneCard (Faculty/Staff/Student)
Pathway Class Schedule with Student Name, ID and Current Enrollment Status
III. Agreement of Understanding
I,
understand that my UMKC Student/Membership Account
will be charged based upon the UMKC/SRC Clean Commute Membership Guidelines which I have read and agree to.
I also understand that if all balances are not paid by University billing dates, they are subject to late fees and finance charges assessed
by the University. I hereby declare that all information I have provided is accurate and reliable.
Dated this
day of
, 20
By
Authorized Agent
Member Signature
Thank you for choosing Swinney Recreation Center’s Clean Commute program.
Please ride safely.
1/2014