Your Cycling for Parkinson’s 14-Day Free TrialStart Form and Waiver GENERAL INFORMATIONName* First Last Email* Enter Email Confirm Email Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM slash DD slash YYYY Gender* Female Male Other Emergency Contact*Emergency Contact's Relationship*Emergency Contact's Phone*Choose Your Tier*All our subscriptions begin with a 14-day free trial. Although you will need to enter your credit card details, your card will not be charged for 14 days. You can cancel anytime within the 14 days and you will not be charged. Tier 1, $49/month, Unlimited Classes Tier 2, $159/month, Unlimited Classes plus Monthly Calendar Tier 3. $269/month, Unlimited Classes plus One-on-One Coaching Total $0.00 Credit Card*Card Details Cardholder Name Cycling for Parkinson's General Release of Liability and Covenant Not to Sue1. In consideration of permitting me to participate in coached exercise and/or training programs, I HEREBY acknowledge that physical exercise and physical training and involves the risk of serious injury and/or death and/or property damage. . I HEREBY RELEASE, WAIVE, AND DISCHARGE Cycling for Parkinson's and its parent company, and any of its owners, officers, instructors, coaches, trainers, agents, contractors, or employees (the Releasees) FROM ALL LIABILITY TO MYSELF, my personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO MY PERSON OR PROPERTY OR RESULTING IN MY DEATH, NOW AND FOREVER, ARISING OUT OF OR RELATED TO MY PARTICIPATION IN EXERCISE COACHING OR TRAINING OR ANY RELATED ACTIVITIES, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I agree to the above paragraph.*2. I HEREBY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, now and forever, arising out of OR RELATED TO MY PARTICIPATION IN EXERCISE COACHING OR TRAINING OR ANY RELATED ACTIVITIES, whether foreseen or unforeseen and whether caused by the negligence of the Releasees or otherwise. I agree to the above paragraph.*3. I HEREBY agree to INDEMNIFY and SAVE and HOLD HARMLESS the Releasees from any loss, liability, damage or cost any of them may incur, now and forever, arising out of OR RELATED TO MY PARTICIPATION IN EXERCISE COACHING OR TRAINING OR ANY RELATED ACTIVITIES, whether caused by the negligence of the Releasees or otherwise. I HEREBY acknowledge that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES and agree that this agreement and release extends to all acts of negligence by Releasees. I agree to the above paragraph. I agree to the above paragraph.*4. I HEREBY ACKNOWLEDGE I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it, am aware of its legal consequences, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. I understand that this agreement represents the entire agreement between the parties regarding the subject matter hereof and supersedes any prior or contemporaneous agreements. I understand that this agreement may not be orally modified and I am not relying on representations made by anyone other than those set forth in this agreement. I ALSO ACKNOWLEDGE that the Release included in this agreement is intended to be as broad and inclusive as permitted by the laws of the Province or State in which the activities are conducted and that if any portion of this agreement and release is held invalid, the balance shall continue in full legal force and effect. I agree to the above paragraph.*Consent* By digitally submitting this document I accept its terms and conditions and I state that I am over 18 years of age.BY WAY OF MY VOLUNTARY DIGITAL SUBMISSION, I AGREE THAT I HAVE FULLY READ AND UNDERSTAND THIS DOCUMENT IN ITS ENTIRETY. I UNDERSTAND THAT THIS IS A LEGALLY BINDING CONTRACT NOT TO SUE AND I AGREE TO BE BOUND BY IT.* Δ
