Waiver And Disclaimer And Authorization/consent Form printable pdf download

MOTORCYCLE SAFETY CENTER OF VIRGINIA, INC.

Waiver & Release of Liability – page 1 of 2

PLEASE READ CAREFULLY, THANK YOU.

In consideration of Virginia Department of Motor Vehicles (DMV) and Motorcycle Safety Center of Virginia, Inc.

(MSCV) furnishing services and/or equipment to enable me to participate in the Motorcycle Rider Education class, I

acknowledge that I have read and agree to the following terms and conditions:

I fully understand, agree and acknowledge that: (a) Risks and dangers exist in my use of motorcycles and

motorcycle equipment and my participation in the Motorcycle Rider Education Class activities; (b) My participation in

such activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury,

disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability; (c)

These risks and dangers may be caused by the negligence of myself, the owners, employees, officers or agents of DMV,

MSCV, the negligence of the participants, the negligence of others, accidents, breaches of contract, forces of nature or

other causes. (d) These risks and dangers may arise from foreseeable or unforeseeable causes; and (e) By my

participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility

for any losses and/or damages, whether caused in whole or in part by the negligence or other conduct of the owners,

agents, officers, or employees of DMV, MSCV or by any other person.

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I, on behalf of myself, my personal representatives and my heirs hereby voluntarily agree to release,

waive, discharge, hold harmless, defend and indemnify DMV, MSCV and its owners, agents, officers and employees from

any and all claims, suits or causes of action for bodily injury, property damage, wrongful death, loss of services or

otherwise which may arise out of my use of the motorcycles and motorcycle equipment or my participation in the

Motorcycle Rider Education Class activities. I specifically understand that I am releasing, discharging and waiving any

claims or actions that I may have presently or in the future for the negligent acts or other conduct by DMV, MSCV and

its owners, agents, officers or employees.

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I understand, in the event of an accident, injury, or illness, medical assessment and treatment may be

necessary. In these instances, MSCV and its owners, agents, officers, employees and/or contractors will recommend

911 be contacted for the purpose of assessing, treating and referring individuals requiring these services. I understand

that basic first aid treatment may be necessary at the training site or that advanced treatment measures may be

recommended by 911-dispatch. I understand and acknowledge MSCV and its owners, agents, officers, employees and

contractors are not licensed or trained medical care providers and as such, do not assume responsibility for the

evaluation or treatment of injuries. Individuals sustaining minor injuries limited to superficial abrasions, cuts or

bruises may utilize basic first aid equipment/supplies available at each training site. Individuals refusing basic first aid

or 911 notifications will be provided with a form to sign acknowledging these services were offered and declined by

the involved individual.

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Students under the age of 18: As the parent or legal guardian of a minor under the age of 18, I understand,

acknowledge and provide my permission for MSCV and its owners, agents, officers, employees and/or contractors to

initiate basic first aid treatment and/or contact 911 dispatch in my absence from the training site. Furthermore, I

understand, in the event the minor student refuses 911 notification or transport, he/she will be provided with a refusal

form to sign documenting such. Knowing this, I provide the minor student with my permission as his/her parent or

legal guardian to provide permission or refusal for basic first aid and/or 911-dispatch notification.

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Revised: December 31, 2016

Waiver And Disclaimer And Authorization/consent Form