The Motorcycle Club

Motorcycle Waiver and Release form
The Motorcycle Club

Motorcycle Waiver and Release form
In signing this document I represent that I am fully knowledgeable of the danger and hazards associated with riding motorcycles. I certify that I am duly licensed and competent to operate a motorcycle in a safe manner, and the vehicle is in a safe operating condition. I will be riding on public highways and am solely responsible to determine the speed and operational characteristics of my motorcycle while participating in the tour. I hereby release and hold harmless, the motorcycle club and any of it's executives or members, Cal Poly Pomona and any of it's executives or members, against any and all claims, causes of action, or any other liability of any kind arising from my activity of touring by motorcycle.

I certify that I have no known physical or mental impairment that may affect my safety or the safety of the group. I understand that the choice or wearing a helmet or other protective gear is solely my own and that I am responsible for my compliance with al state laws, including those regarding helmets. I certify that I am not under the influence of any narcotic, alcohol, or other drug that may impair my understanding or judgement and that I will not at any time during the tour operate my motorcycle under the influence of any drug. I also understand that this Waiver and Release in force for the duration of my membership and covers any and all activities.
Signature Date
Name (print) Phone #
Drivers license number State
Signature of passenger
Witness signature
Witness name (print)
Please provide the following emergency information:
Emergency contact person
Relation Phone (home) (work)
Vehicle insurance carrier Policy #
Health insurance carrier (rider) Policy #
Health insurance carrier (passenger) Policy #
Please list any allergies, medicines taken regularly, or medical conditions

Email:
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