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Waiver

Waiver

Waiver and Release Form 

By signing this WAIVER AND RELEASE FORM (the “Release”), I understand and agree to the following terms and conditions so that I may participate in all classes, activities, events and other programs

(collectively, the “Activities”) provided by Cycletique, LLC, its affiliates, successors and assigns (collectively, “Cycletique”):

I have read and understand the Bike Safety Instructions that are posted on Cycletique’s website (www.cycletiquepgh.com), a copy of which is available on request, and acknowledge that I must comply with the Safety Instructions and Procedures at all times during my participation in the Activities and use of the facilities. I understand that if I don’t follow the Safety Instructions and Procedures that Cycletique reserves the right to ask me to leave the Cycletique facilities and to deny me future access to the Cycletique

facilities.

I understand that participation in the Activities can result in injuries including scratches, bruises, sprains, joint or back injuries, heart attacks, concussions, paralysis and death. I understand and acknowledge that the American College of Sports Medicine and Cycletique advises all persons to seek medical evaluation and clearance prior to beginning any exercise program. I represent that I am healthy and able to engage in the Activities provided by Cycletique and have obtained a medical evaluation and clearance prior to my participation in the Activities. I acknowledge and agree that the staff at Cycletique reserves the right at any time to deny me the ability to participate in Activities if the staff feels it would be unsafe. I understand that I am solely responsible for all health risks associated with such Activities. I AM AWARE AND UNDERSTAND THE RISK OF SERIOUS INJURY ASSOCIATED WITH MY PARTICIPATION IN ANY OF THE ACTIVITIES OR USE OF THE FACILITIES. I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITIES WITH KNOWLEDGE OF THE DANGERS INVOLVED AND AGREE

TO ACCEPT AND ASSUME FULL RESPONSIBILITY FOR ANY AND ALL RISKS OF INJURY, DEATH, PROPERTY DAMAGE, OR OTHER LOSS THAT MAY BE SUSTAINED BY ME AS ARESULT OF MY PARTICIPATION IN THE ACTIVITIES OR USE OF THE FACILITIES, WHETHER CAUSED BY THE NEGLIGENCE OF CYCLETIQUE OR OTHERWISE.

TO THE FULLEST EXTENT PERMITTED BY LAW, I, ON BEHALF OF MYSELF, MY HEIRS, EXECUTORS, ADMINISTRATORS, LEGAL REPRESENTATIVES AND ASSIGNS, FULLY AND FOREVER RELEASE, INDEMNIFY AND HOLD HARMLESS CYCLETIQUE AND ITS OWNERS, DIRECTORS, OFFICERS, EMPLOYEES, AND/OR AFFILIATES FROMANY AND ALL CLAIMS, DAMAGES, LIABILITIES, LOSSES, DEMANDS, RIGHTS OF ACTION, CAUSES OF ACTION, COSTS AND EXPENSES OF ANY KIND, PRESENT OR

FUTURE, KNOWNORUNKNOWN, ANTICIPATED OR UNANTICIPATED, RESULTING FROM OR ARISING OUTOFMYPARTICIPATION IN THE ACTIVITIES AND USE OF THE FACILITIES, WHETHER DUE TO NEGLIGENCEO F CYCLETIQUE OR OTHERWISE.

I acknowledge and agree that this Release is the sole and entire agreement between Cycletique and me with respect to the subject matter contained in this Release. If any term or provision of this Release is deemed invalid, illegal or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect, invalidate or render unenforceable the remaining terms and provisions of this Release.

I acknowledge and agree to abide by Cycletique’s prohibition on photography, videotaping, filming or audio recording at its facilities without prior written permission of Cycletique’s management (“No-Photo

Policy”). I ACKNOWLEDGE AND AGREE THAT IF I BREACH THE NO-PHOTO POLICY, THATI SHALL PAY CYCLETIQUE $5,000 PER INCIDENT AS LIQUIDATED DAMAGES. I AGREE THAT QUANTIFYING LOSSES ARISING FROM MY BREACH OF THE NO-PHOTO POLICY IS INHERENTLY DIFFICULTINSOFAR AS THE BREACH MAY IMPACT CYCLETIQUE’S REPUTATION AND FURTHER STIPULATE THAT THE AGREED UPON SUM ISNOTA PENALTY, BUT RATHER AREASONABLE MEASURE OF DAMAGES.

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS RELEASE AND UNDERSTAND ITS

CONTENTS. I UNDERSTAND THAT BY SIGNING THIS RELEASE, I AM WAIVING CERTAIN LEGAL RIGHTS AND AGREE TO DO SO VOLUNTARILY.

____________________________________________________________________________________

Signature (if 18 years of age or older)                                                                            Date

____________________________________________________________________________________

Printed Name                                                                                                                        Address

____________________________________________________________________________________

Emergency Contact Name                                                      Emergency Contact Phone Number

 

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 of this Release and affirm that child is at least 16 years of age and 4’11” tall.

____________________________________________________________________________________

Signature

____________________________________________________________________________________

Printed Name of Parent or Legal Guardian                                

 

Bike Safety Instructions

  1. Inspect the bike prior to the riding tom a k e certain that all parts are operating properly.
  2. Ensure that Adjustment Knobs (for seat height, fore and aft and handlebar) are tight and do not interfere with the rider’s range of motion during class.
  3. The maximum weight on the bike should not exceed 350 pounds.
  4. Keep hands, feet and objects free of moving parts of the bike at all times.
  5. To stop your bike, you should always gradually stop and try to avoid sudden stops. In the case of emergency to stop immediately press down on the resistance knob.
  6. Never turn the wheel by hand.
  7. Listen to your body at all times and ride at the pace that feels right for you.
  8. If you feel dizzy, lightheaded, have difficulty breathing or have a tightening in your chest, bring your bike to a gradual stop and ask for assistance.
  9. Stay hydrated and drink throughout the ride. Take as many breaks as your body needs.
  10. Always have some resistance on the bike so that the pedals do not rotate freely.
  11. Do not attempt to do movements or change positions fast before you have practiced them at slower speeds. Stay in control of the bike at all times.
  12. Do not use the bike without proper footwear. Never ride in bare feet. The bike pedals are compatible with SPD and Look clips.
  13. Never remove your feet while the bike is still in motion.
  14. Focus on form and posture throughout the ride.
  15. Keep your bike clear of obstructions on the floor (i.e. clothes etc.)
  16. If the bike is not operating correctly, please slow the pedals to a controlled stop, dismount the bike and inform the instructor.
  17. Do not dismount the bike until the pedals have fully stopped. Use the Resistance Adjustment Knob to slow the pedals to a controlled stop before you dismount the bike
  18. After each use of the bike, please wipe down the bike.
  19. Keep children away from the bike. Parts that move and appear dangerous to adults can appear safe to children.
  20. Children under 4’11 should not ride the bike. The bike is designed for riders 4″11 and above.                                            
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