SMART Ride 18 Waiver

RELEASE OF LIABILITY AND MEDICAL INSURANCE WAIVER  

I wish to participate in The SMART Ride 19 (Southern Most AIDS/HIV Ride Twenty-Twenty Two (“Event”), which I understand to be  a two-day, 165-mile non-competitive bicycle fundraising ride and related events, including but not limited to training rides. I  understand that by participating in the Event, I will be using public streets and facilities where many hazards exist and I am aware  of and appreciate the risks that may result. I am also aware that accidents occur while bicycle riding and that I may be seriously  injured or killed as a result. I am voluntarily participating in this event with knowledge of the dangers involved and I agree to accept  any and all risks of injury or death. I have read and understood the description of the ride provided on http://www.thesmartride.org  for the Event and agree to abide by them and to abide by all other rules and regulations established for the Event.  

In consideration for being permitted to participate in the Event, I agree to assume all risks and to release, waive, forever discharge  and covenant not to sue and hold harmless the “Benefitting Agencies”, the “SMART RIDE”, the “Additional Organizations,  Governmental Entities” and TSR Adventures, Inc., a Florida not for profit corporation (it’s officers, directors, employees, volunteers  and agents) (collectively known as “SR19”) as they are defined and frequently updated on the Website www.TheSmart19 Ride.org  (hereafter known as the “Website”) or part of the Rules and Regulations and are presently on that website for the Event, the  volunteer organizers and all other entities we travel through, their affiliated organizations, designated beneficiaries, sponsors,  officials, participating clubs, communities, organizations, Friends of The SMART Ride and all other government, or public entities  (and all their respective officers, directors, agents, employees and members) (collectively known as “Additional SR18”) who,  through negligence, carelessness or any other cause, might otherwise be liable to me from all liabilities, claims, costs, expenses,  damages, losses and obligations of any kind or nature which may arise or result (either directly or indirectly) from my participation  in the Event. I understand that the Event may expose me to risks other than those listed above and that the risks may not be  reasonably foreseeable to me or to SR18 and to the Additional SR18. In consideration for being allowed to participate in the Event,  I hereby assume all risks associated with the Event, even those risks which are not reasonably foreseeable at this time.  I intend by this waiver and Release to release, in advance, and to waive my rights and discharge all of SR18 and the Additional  SR18 and of the persons and entities mentioned above, from any and all claims for damages for death, personal injury or property  damage which I may have, or which may hereafter accrue to me, as a result of my participation in the Event, even though those  damages may arise from negligence on the part of the persons or entities being released. I understand and agree that this Waiver  and Release is binding on my heirs, assigns and legal representatives.  

I am physically capable of participating in the Event. If I am aware of or under treatment for any physical infirmity, ailment or illness,  my medical care provider knows of and has approved my participation in the Event. I acknowledge that I, and no one else, am  solely responsible for my personal health and safety, the condition of the bicycle I will be riding, and the personal property I bring  with me. I have read the ride description and rules for participation in the Event and I will abide by all rules and regulations  established by the Event organizers and personnel as well as the Florida Vehicle Code. I agree to wear a properly fitted, adjusted  ANSI, ASTM, or SNELL-certified helmet during the Ride at all times. Portions of the Event will be photographed, video- and audio taped, and otherwise recorded. I agree that my name, photograph, voice and/or likeness, and information related to my  participation in the Event (collectively, “Images”) may be used by SR19 for publicity and other purposes (“Promotion”). I hereby  grant SR19 the irrevocable, perpetual, exclusive, worldwide right to (i) use my Images for Promotion, (ii) create composite or  computer manipulated materials from my Images, (iii) use, reproduce, distribute, exhibit, transmit and publish my Images in any  media, and (iv) assign the aforementioned rights to third parties. I hereby consent to and authorize in advance the aforementioned  grants, without compensation, and waive any rights of privacy or publicity I may have in connection therewith.  

I acknowledge that I have been asked to have and provide proof of medical and accident insurance. If I do not provide this to the  Event or do not have personal medical insurance or am not covered under any medical plan, I accept full responsibility for any  costs incurred for medical treatment and evaluation regardless of the cause of an accident by me or to me. I understand that it is  my responsibility to provide payment to any hospital, emergency response technician, emergency transport company or any other expense, that is chargeable to me as a result of injury or illness during the SMART Ride to me or caused by me to someone else or  their property.  

I have carefully read this Waiver and Release and fully understand its contents. I certify that I am at least 18 years of age at time of  registration. I am aware that this is a RELEASE OF LIABILITY and a contract between me and the persons and the entities mentioned above and all of the respective officers, directors, employees, agents and representatives of the Benefitting Agencies,  SR19, Additional SR19, Additional Organizations, Governmental Entities the volunteer organizers and all other entities we travel  through, their affiliated organizations, designated beneficiaries, sponsors, officials, participating clubs, communities, organizations,  Friends of The SMART Ride and all other government, or public entities (and all their respective officers, directors, agents,  employees and members) and I sign it of my own free will. I may physically sign this document or electronically sign it by a click  agreement on the Website.  

This agreement is intended by the parties to be fully severable. If any portion of this agreement is held to be invalid or overly broad,  the entire agreement will not be invalidated; rather, the agreement will be deemed modified so as to be applied to the fullest extent  permitted by applicable law. This agreement shall be interpreted and enforced under the laws of the State of Florida. Any legal suit,  

action or proceeding arising out of or relating to this agreement shall be commenced in a federal or state court in Broward County,  Florida, and the parties hereto submit to the exclusive jurisdiction and venue of any such court in any such suit, action or  proceeding. This agreement is the complete understanding between the parties.  

THIS IS AN IMPORTANT LEGAL DOCUMENT. READ IT CAREFULLY BEFORE PROCEEDING  

Place Label Here 

Signature________________________________________ Date______________  Participant #: _______________ 

Last Name: __________________ 

First Name: _________________