California Motorcyclist Safety Program

Student Registration Form

Clutch Motorcycle Training Inc.

Site Name: ____________________________________________________________ Date _________________________

Personal Data

NAME: _____________________________________________________________________________________________________
First Middle Last

ADDRESS: __________________________________________________________________________________________________
Street City State Zip

DOB MM/DD/YY _____________________ AGE ______ SEX r M r F

WORK PH _____________________________ HOME PH ________________________ MOBILE ____________________________

EMAIL ___________________________________________________

Acceptable Government Issued Photo ID:

r State Driver’s License r Permit # ________________________ State: __________ Expiration Date: _______________

r State Identifcation # ____________________________________ State: __________ Expiration Date: _______________

r Foreign Driver’s License # _________________________ Country: ____________________ Expiration Date: _______________

r Passport # ______________________________ Country: ___________________________ Expiration Date: _______________

Verified Government Issued Photo ID By: ______________

(initial)
ON-STREET RIDING EXPERIENCE
1. Have you ridden a street motorcycle regularly in the last five years? r Yes r No
2. How much street riding experience do you have? (check one)
r Less than 500 miles r 500 to 2000 miles r More than 2000 miles
3. How long have you been riding? _______ years
4. Have you ridden off road? r Yes r No

5. How many on-street miles have you ridden in the past year? ______________ miles
6. Do you own a street motorcycle/motorscooter? 1. r yes 2. r no If yes, what size? ________cc
7. What is your primary reason for riding a motorcycle/motorscooter on street?
r Commuting r Recreation r Other _____________________________
8. Have you ever been involved in an on-street motorcycle/motorscooter accident? r yes r no

9. How did you hear about this course? (Check all that apply)
r Friend r Tradeshow r Catalog r School r Online Search r DMV
r Dealer r Insurance r Courts r Magazine r CMSP website r Brochure
r Other explain_______________________
10. Did you call for Motorcyclist Training Course information? r Yes r No
11. Have you ever taken this course before? r Yes r No
12. May CMSP contact you in the future? r Yes r No
___________________________________________________________________________________________________________
do not write below this line office copy
written test score __________ riding test score _____________ DL 389 Cert. no: _______________
check one: r passed r failed r dropped early r dropped late r did not finish
If student is a carry over from a previous class, check this box r
Rev 3/15
 CALIFORNIA MOTORCYCLIST SAFETY PROGRAM
COURSE WAIVER AND INDEMNIFICATION

Participation in this course requires physical stamina, motor coordination, and mental alertness. The undersigned hereby attests that he/she has no
known physical or mental limitations and has not used any form of alcohol, prescription or non-prescription drugs that could impair his/her performance
in this course. Participants under 18 years of age must have this form signed by a parent or guardian.

READ CAREFULLY: THIS SECTION IS A LEGAL RELEASE, ASSUMPTION OF RISK, WAIVER AND COVENANT NOT TO SUE AGREEMENT

______ Clutch Motorcycle Training Inc.

In consideration of ___________________________________________, the State of California, California Motorcyclist Safety Program, Total
Initials

agents (the "Motorcycle Course Providers"), furnishing services, equipment, and/or curriculum to enable me to participate in the Motorcycle
Rider Education Course I agree as follows:

______ I fully understand and acknowledge that: (a) there are DANGERS AND RISK OF INJURY, DAMAGE, OR DEATH that exist in my use of
Initials motorcycles and motorcycle equipment and my participation in the Motorcycle Safety Course 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 OR TOTAL PARALYSIS, OTHER AILMENTS THAT COULD CAUSE SERIOUS DISABILITY, OR DEATH; (c) these
risks and dangers may be caused by negligence ofthe Motorcycle Course Providers; the negligence of others, including other Motorcycle
Rider Education Course participants; and may arise from foreseeable or unforeseeable causes; and (d) by participating in these activities
and/or using the equipment, I, on behalf of myself, my personal representatives and my heirs, hereby assume all risks and all
responsibility, and agree to release the Motorcycle Course Providers for any injuries, losses and/or damages, including those caused
solely or in part by the negligence of the Motorcycle Course Providers, or any other person. If I have brought a motorcycle to use in the
Motorcycle Rider Education Course, I also agree that this release applies to any damage that occurs to it during the Motorcycle Rider
Education Class.

______ I fully understand and acknowledge that: (a) there are DANGERS AND RISK OF INJURY, DAMAGE, OR DEATH that exist in my use of
Initials motorcycles and motorcycle equipment and my participation in the Motorcycle Rider Education Course activities;

______ I agree and understand that, on behalf of myself, my personal representatives and my heirs, I am relinquishing any and all rights I now have or
Initials may have in the future to sue the Motorcycle Course Providers for any and all injury, damage, or death I may suffer arising from motorcycle
riding or its equipment, including claims based on the Motorcycle Course Providers' negligence.

______ I HAVE READ THIS WAIVER AND RELEASE AGREEMENT AND BY SIGNING BELOW I AGREE IT IS MY INTENTION TO ASSUME ALL
Initials RISKS AND RELEASE THE ABOVE-NAMED MOTORCYCLE COURSE PROVIDERS FROM LIABILITY FOR PERSONAL INJURY,
PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
I have had the opportunity to ask any questions about the above waiver and release and I understand its terms and meaning.

____________________________________________________ ________________________________________________________________
Participant Name - Please Print Participant Signature

__________________________ ____________________________________________________ _______________________________

Date Signature of parent or legal guardian if less than 18 years old Relationship

READ CAREFULLY: THIS SECTION IS AN INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

Clutch Motorcycle Training Inc.

Initials lessors, its training locations, the training sponsor, the owner of the training motorcycle, and the owner of the land upon which training occurs,

and/or curriculum to enable me to participate in the Motorcycle Rider Education Course, I agree as follows:

______ I, on behalf of myself, my personal representatives and my heirs, agree to hold harmless, defend, and indemnify the Motorcycle Course
Initials Providers from any and all claims, suits, or causes of action by others for bodily injury, property damage, or other damages which may arise
out of my use of motorcycles and motorcycle equipment or my participation in the Motorcycle Rider Education Course activities, including
claims arising from the Motorcycle Course Providers' or any other party's negligence.

______ I HAVE READ THIS INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND BY SIGNING I AGREE IT IS MY INTENTION TO
Initials ACCEPT LEGAL RESPONSIBILITY AND PAY FOR ANY LOSS FOR CLAIMS OR LAWSUITS AGAINST ABOVE-NAMED MOTORCYCLE
COURSE PROVIDERS ARISING FROM MY PARTICIPATION IN THE MOTORCYCLE RIDER EDUCATION COURSE.

____________________________________________________ ________________________________________________________________
Participant Name - Please Print Participant Signature

__________________________ ____________________________________________________ _______________________________

Date Signature of parent or legal guardian if less than 18 years old Relationship

Rev 1/15
CLUTCH MOTORCYCLE TRAINING INC. COVID WAIVER

Clutch Motorcycle Training Inc. COVID Waiver Waiver and General Release of Liability Relating to
Coronavirus/COVID-19. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by
the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical
knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by
contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be
infected and show no symptoms and therefore spread the disease. The exact methods of spread and
contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has
shown that COVID-19 can cause serious and potentially life-threatening illness and even death. Clutch
Motorcycle Training Inc, the training sponsor, the owner of the training motorcycle and premises upon
which training occurs, including each of their affiliates, subsidiaries, members, employees, officers,
coaches, instructors, aides, and/or agents (the “Released Parties”)cannot prevent you from becoming
exposed to, contracting, or spreading COVID-19 while participating in this CMSP or TCT motorcycle class
or utilizing the Released Parties’ services or premises (collectively, the “Course”). It is not possible to
prevent against the presence of the disease. Therefore, if you choose to participate in the Course, you
may be exposing yourself to and/or increase your risk of contracting or spreading COVID-19.
ASSUMPTION OF RISK: Have read and understood the above warning concerning COVID-19.I hereby
choose to accept the risk of contracting COVID-19 for myself, and for my family members or others who
may expose, in order to participate in the Course. These services are of such value to me that I accept
the risk of being exposed to, contracting, and/or spreading COVID-19 in order to participate in the
Course. WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against
the Released Parties in connection with exposure, infection, and/or spread of COVID-19 related to my
participation in the Course. I understand that this waiver means I give up my right to bring any claims
including for personal injuries, death, disease or property losses, or any other loss, including but not
limited to claims of negligence, and give up any claim I may have to seek damages, whether known or
unknown, foreseen or unforeseen. OTHER TERMS: I fully understand and agree that (a) this Release is
intended to be as broad and inclusive as permitted by the laws of the State in which the Course is
conducted; (b) if any portion of this Agreement is for any reason held invalid or legally unenforceable,
then the balance shall, notwithstanding, continue in full force and legal effect; and (c) I have had the
opportunity to ask any questions about this Agreement and I fully understand its terms and meaning. I
HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS WAIVER AND GENERAL
RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING
LIABILITY AS DESCRIBED ABOVE.

Signature: __________________________________

Print Name: ________________________________________________________

Date: ___________________________

I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by
signing below, I hereby do consent to the terms and conditions of this Waiver and General Release.
Signature: __________________________________________________________ Date: ________ Print
Name: ________________________________________________________
 Clutch Motorcycle Training Inc.

STUDENT AGREEMENT FORM

The California Motorcyclist Safety Program Motorcyclist Training Course (CMSP

MTC) is designed for the novice rider with no (or limited) street-riding
experience. However, you MUST be PROFICIENT in riding a bicycle, as
balance is required in the operation of a 2-wheeled vehicle.

You must read the CMSP Student Handbook before attending classroom 1. To
download a copy of the handbook, go to: http://bit.ly/2qjNH5f

This is a PASS or FAIL course. Students who fail the written or riding test, have
60 days to re-test and must schedule their re-test with the Clutch office via
phone or email. The re-test fee is $50 and payment can be made either on line or
in person.

LATE, NO SHOW, SELF DROP & COUNSELED OUT students have the
opportunity to attend as a stand-by. The stand-by fee is $100. There is no
guarantee of entrance as a stand-by. Students who want a guaranteed spot
into the CMSP-MTC may schedule on line and pay the full fee. Stand-by riders
must check in 15 minutes prior to the Range 1 start time with a valid photo I.D.
and all riding gear. Stand-by students have 60 days from their original date
to complete the course.

SAFETY IS PARAMOUNT. Instructors will determine whether or not a student is

safe to continue. All CMSP Certified Instructors complete a rigorous and
thorough training program. The primary goal of an Instructor is to keep
everyone, including themselves, safe. If a student exhibits an unsafe act,
either deliberately or by accident, said student may be counseled out of the
CMSP MTC. A student may also be counseled out for a series of other factors
including but not limited to; inability to control the clutch or throttle, lack of
balance, intimidating another student or Instructor, using foul or offensive
language, or displaying an attitude that interferes, contradicts, or otherwise
inhibits the role of the CMSP Instructor’s primary goal.
Continued…
Registration in the CMSP MTC is non-transferable and non-refundable. If a
student is unable to make it to the class she/he reserved, she/he may attend as a
stand-by for up to 60 days of the original enrollment date for the $100 stand-by
fee OR may sign up on line and reserve new confirmed dates at the full fee.

REQUIRED RIDING GEAR:

1. Full face or 3/4 helmet (Clutch will provide loaners)

2. Full-fingered motorcycle street gloves (Clutch will provide loaners)
3. Long-sleeved shirt or jacket.
4. Jeans or cargo pants with no holes or rips (NO Leggings or Sweat pants)
5. Sturdy over-the-ankle BOOTS with little or no heel. (NO Cloth Shoes or
Dress Shoes with elastic around the ankle)
6. Eye Protection (sunglasses, goggles, helmet visor)

WEATHER Policy: We ride RAIN or SHINE, so please come prepared with

proper rain gear and a change of clothes.

DMV: CMSP course graduates are required to complete the motorcycle permit
written test. Go to: http://www.dmv.ca.gov/portal/dmv/dmvheader2/publications
download.

STUDENT HEALTH: We strongly encourage anyone who has a prior or present

injury that could negatively impact their ability to operate heavy machinery, such
as a motorcycle, speak with their doctor before participating in the CMSP MTC.
If Clutch Motorcycle Training Inc. is not notified in advance of a potential health
concern, the student will assume all risk and will release CMTI from all liability.
________________________________________________________________

I HAVE READ, UNDERSTAND AND AGREE TO ALL POLICIES HEREIN:

Signature _______________________________________________________

Printed Name: __________________________________ Date ____________

Clutch Motorcycle Training Inc. • 12405 Venice Blvd., Suite 426 • Los Angeles, CA 90066
 Long Beach BMW Motorcycles
2125 E. Spring Street, Long Beach 90806

There’s no parking inside the dealership lot, so please arrive early

(at least 15 minutes prior to your scheduled classroom time) to find street parking.
Long Beach BMW Motorcycles Thank you!