Name*
Email*
Address*
 
City*
State*
Zip*
Home Phone*
Cell Phone
Date of Birth*

Passenger?YesNo

If you will not have a passenger, please skip to the next section.

Name
Address
 
City
State
Zip

Year
Make
Model
Tag Number

Name
Phone Number

I agree that Unity Outreach, Inc., its Affiliates, Sponsors, Vendors, or their respective officers, directors, employees and agents (hereinafter, the “RELEASED PARTIES”) shall not be held liable or responsible for any injury to me (including paralysis or death) or damage to my property during any motorcycle rides or other activities, even where the damage or injury is caused by negligence. I understand and agree that all attendees and their guests participate voluntarily and at their own risk in all activities and I assume all risks of injury or loss to any person or property, which may result from my participation in activities and event(s). I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE THE “RELEASED PARTIES” FOR ANY INJURY OR DAMAGE TO MYSELF, PASSENTER, OR MY PROPERTY RESULTING FROM, ON IN CONNECTION WITH, ANY MOTORCYCLE RIDES, ACTIVITIES OR EVENTS.

By typing my name below, I certify that I have read this Release of Liability and fully understand it and that I am not relying on any statements or representations made by the “RELEASED PARTIES”.

Name*
Date*