English - 27th Ontario Regional HOG® Rally

CHAPTEREVENT
MEMBERSHIP
ENROLMENT
FORM AND
RELEASEFOR
FORM
FOR ADULTS
RELEASE
ADULTS
Name of Event(s):
Date:
Location:
Retailer:
– THIS IS A RELEASE, READ BEFORE SIGNING –
The undersigned (on my own, and on behalf of my heirs, personal representatives, successors, and assigns), for and in
consideration of the opportunity to participate in a “Ride”, “Poker Run”, “Rally”, “Field Meet” or “Activity” and any other
related H.O.G.® event or activity (hereinafter, the “ACTIVITIES”) associated with, sponsored and/or conducted by Harley
Davidson Michigan Inc., Harley-Davidson Motor Company Inc., its subsidiaries and affiliates, Fred Deeley Imports Ltd.,
Harley-Davidson Owners Group® of Canada Ltd., or my Chapter, the Retailer, event, or location named above and any other
organizers, sponsors, officials, and volunteers; and their respective directors, officers, shareholders, employees, partners,
affiliates, agents, representatives, successors, and assigns (all being collectively referred to hereafter as “RELEASED
PARTIES”) hereby irrevocably release and forever discharge the RELEASED PARTIES from any and all claims, demands,
damages, rights, actions, causes of action, suits, debts, contracts, interest, costs, expenses of any kind whatsoever,
howsoever arising, directly or indirectly, which I now have, or later may have against the RELEASED PARTIES, whether
known or unknown, in law or in equity, in any way resulting from, arising out of, or in connection with my participation in
any and all of the said ACTIVITIES.
Without limiting the foregoing, this Release extends to any and all claims I have or may have against the RELEASED
PARTIES whether or not such claims result from strict liability or negligence on the part of any or all of the RELEASED
PARTIES, or from any action or inaction on my part, during the ACTIVITIES or any claims with respect to the conditions,
qualifications, instructions, rules, or procedures under which the ACTIVITIES are conducted or from any other cause. I
UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE ANY OR ALL OF THE RELEASED PARTIES FOR ANY
INJURY RESULTING TO MYSELF OR OTHERS, OR MY PROPERTY OR THE PROPERTY OF OTHERS, ARISING FROM, OR
IN CONNECTION WITH SAID ACTIVITIES.
In consideration of my being allowed to participate in the ACTIVITIES, I agree to indemnify and hold harmless the
RELEASED PARTIES from any and all liability, claims, causes of action, demands, damages, or any other forms of relief
which might be made against any or all of the RELEASED PARTIES whatsoever, howsoever arising, directly or indirectly
out of or in consequence of my attendance at or participation in the ACTIVITIES.
I hereby warrant and represent that: in the event that I am operating a motorcycle during the ACTIVITIES, I am experienced
in and familiar with the operation and riding of motorcycles and I hold a valid motorcycle operator’s licence (Ontario
Class “M or M2” licence or provincial equivalent), or in the event that I am a passenger on a motorcycle during the
ACTIVITIES, I am experienced in and familiar with being a passenger on motorcycles; I fully understand the risks and
dangers inherent in motorcycling; and I am the age of majority in the Province or Territory that the ACTIVITIES are located
in. I am voluntarily participating in the ACTIVITIES and I expressly agree to assume the entire risk of any accident, personal
injury, including death, property damage, or any other harm which I may suffer as a result of my participation in the
ACTIVITIES, notwithstanding any prevailing weather, road or other conditions, and any other factors which may impact or
affect in any way the conduct of the ACTIVITIES or my participation therein.
©2014 H-D or its affiliates. Harley Owners Group, H.O.G., H-D, Harley, Harley-Davidson and the H.O.G. logo are among the trademarks of H-D U.S.A., LLC.
BY SIGNING THIS RELEASE, I CERTIFY THAT I HAVE READ THIS RELEASE AND THAT I FULLY UNDERSTAND IT, AND
THAT I AM NOT RELYING ON ANY STATEMENTS OR REPRESENTATIONS MADE BY THE RELEASED PARTIES. I FURTHER
UNDERSTAND AND AM AWARE THAT BY SIGNING THIS RELEASE I AM WAIVING CERTAIN SUBSTANTIAL LEGAL
RIGHTS WHICH MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS, AND I MAY HAVE AGAINST
THE RELEASED PARTIES EITHER INDIVIDUALLY OR COLLECTIVELY.
AS A MEMBER OR GUEST OF THE CHAPTER, I AM FULLY AWARE THAT THERE IS A “ZERO ALCOHOL TOLERANCE
POLICY”. I UNDERSTAND AND ACCEPT THAT IN CONSUMING ANY ALCOHOL DURING ANY CHAPTER RIDING EVENT
OR ACTIVITY, IT WILL NULLIFY MY COVERAGE UNDER THE CHAPTER LIABILITY INSURANCE POLICY. I ACKNOWLEDGE
THAT I AM SOLELY RESPONSIBLE AND ACCOUNTABLE AS AN INDIVIDUAL FOR MY ACTIONS, AND HEREBY AGREE
TO ADHERE TO THIS POLICY DURING THE COURSE OF ANY CHAPTER RIDING EVENT AND ACTIVITY IN WHICH I AM
A PARTICIPANT.
PARTICIPANT
Signature
Print Name
Address
City
Prov./State
P.C./Zip
Date
For emergency purposes:
Contact Tel. #
Emergency Contact
©2014 H-D or its affiliates. Harley Owners Group, H.O.G., H-D, Harley, Harley-Davidson and the H.O.G. logo are among the trademarks of H-D U.S.A., LLC.