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Date/Time: Time In: Staff In/Out:_______________/_______________ NAME _____________________________STUDENT ID_________________________________ ADDRESS_______________________________________________________________________ PHONE_____________________________ EMAIL______________________________________ DOB___________________HOW DID YOU HEAR ABOUT US? __________________________ _________________________________________________________________________________
The following is a warning, release of liability, assumption of risk, and indemnity agreementbetween the renting/sharing party (hereinafter referred to as “I”), and the rental/sharingcompany (hereinafter collectively referred to as Green Bike Share).
1. I acknowledge that bicycling can be a hazardous activity that involves risks that may be injurious or fatal.I agree to assume all risks included in the activity. I acknowledge that Green Bike Share requires me to wear a helmet at all times while riding a Green Bike Share bicycle. Green Bike Share provides lights and reflectorsand requires users to turn on lights while riding at night as required by the State of California.2. I acknowledge that Green Bike Share is not responsible for the conditions of roads, routes, or surfaces onwhich I will be riding a rented bicycle from Green Bike Share. I acknowledge that flat tires are an inherentrisk of bicycle riding - I further understand that although routes may be suggested to me for riding GreenBike Share, the routes are not owned, monitored, managed, or kept by Green Bike Share and I thereforerelease Green Bike Share from any responsibilities for conditions of said areas.3. I agree to indemnify, defend, and hold harmless Green Bike Share, including owners, officers, agents,employees, volunteers, participants, landlords, tenants, sponsors, advertisers, The Regents of the Universityof California, and any other entity or person acting on their behalf, from any and all liability for damage,injury, or death to myself, or to any other person or property, which are in any way connected to my participation in the activity stated herein. I waive my right to present any legal claim or lawsuit against theseentities or persons regardless of how any damage, injury, or death may have occurred, through negligence or any other manner considered through legal claim.4. I agree to release, discharge, indemnify and hold harmless all manufacturers and/or distributors of anyequipment provided to me by Green Bike Share including but not limited to bicycles and helmets, from anyand all liability for damage, injury, or death to myself, or any other person or property, which are in any wayconnected to my participation in the activity stated herein. I hereby waive my right to present any legal claimor lawsuit against these entities regardless of how any damage, injury or death may have occurred, throughnegligence or any or any other manner considered through legal claim.5. I agree to confirm receipt of a lock and key before departing Green Bike Share rental premises with a