Parental Consent Policy
ALYN Wheels of Love Bike Ride
Participation of Minor
Release and Appointment of Temporary Guardian
Date______________
We, the undersigned, are the parents of ______________________, Israel I.D. number [or passport nationality and number] ___________________, a minor under the age of 18 (the “Minor”) participating in the ALYN Wheels of Love Bike Ride (the “Ride”). As a condition to the Minor participating in the ride, we agree to and accept the following on the behalf of the Minor:
Release and Acknowledgement of Terms of Participation
1. We understand that cycling is a strenuous activity and that the Minor must therefore be fit and enjoy sufficient good health to participate. We understand that as a participant in the Ride the Minor will ride for about 100 km (60 mi) a day, very likely in hot weather. To the best of our knowledge, the general state of health and fitness of the Minor is good, and we take full responsibility for the Minor’s participation in the Ride. The Minor is physically capable of completing the Ride. If we are aware of or the Minor is under treatment for any physical infirmity, ailment or illness, or any medical condition which could be adversely affected by exercise, particularly a heart condition, or if we have any doubt about the Minor’s health, the Minor’s medical care provider knows of and has approved of the Minor’s participation in this event.
2. We understand that in participating in this event, the Minor will be using public streets and facilities where many hazards exist, and we are aware of and appreciate the risks that may result. We are also aware that accidents may occur during this event which may result in serious injury or death. The Minor is voluntarily participating in this event with our approval and with the Minor’s and our knowledge of the dangers involved and we and the Minor agree to accept all risks of injury or death.
3. In consideration of the Minor being allowed to participate in this event, we agree on behalf of ourselves and the Minor to assume all risks and to release and hold harmless the Ride and any of its designated organizers, volunteers, sponsors, officials, friends organizations, any physician or other medical team members, ALYN Hospital and its affiliates, employees or agents, the Temporary Guardian (as defined below) and any other person or entity involved with the Ride (the “Ride Affiliates”) who through negligence, carelessness or any other cause might be liable to the Minor or us, and agree that none of the foregoing will be held responsible for any accident, injury, death or loss or damage to property, regardless of how it arises. We understand that this waiver and release is binding on us and the Minor and on the Minor’s heirs, assigns and legal representatives.
4. We agree that the Minor will examine and use any bicycle and, where appropriate, other equipment supplied, at the Minor’s and our own risk, and that we and the Minor shall be in all respects responsible for his or her own safety and for all personal property the Minor brings with him or her. At all times while participating in the Ride, the Minor will wear a helmet as well as any other cycling shirt or vest or other gear designated by the Ride organizers.
5. We understand that in order to participate in this event, the Minor must raise the minimum sponsorship prior to the date of departure. If the Minor is not able to participate in the Ride for any reason, all donations received by the Minor will nevertheless be retained by ALYN Hospital and will be allocated to the total sponsorship of the event.
6. We and the Minor will read the Ride description and rules for participation and the Minor agrees to follow the instructions of the Ride organizers.
7. We and the Minor understand that the name, photograph, voice or likeness of the Minor may be used by ALYN Hospital or the Ride organizers. We consent to and authorize such use and waive any rights of privacy we or the Minor may have in connection therewith. We understand that we will not benefit financially from any such use.
We have carefully read the terms and conditions set forth above and understand their contents. By signing below we agree on behalf of the Minor to abide by the terms and conditions set forth above and the reasonable instructions of the Ride organizers. We understand that this is a release of liability and a contract between ourselves and the persons and entities mentioned above.
Appointment of Temporary Guardian
In addition, we, the undersigned, hereby appoint ______________________, I.D. no. [or passport nationality and number] ____________ (the “Temporary Guardian”) to serve as temporary guardian with respect to the Minor during the period of the Ride. We have instructed the Minor to follow all instructions and guidance provided to him by the Temporary Guardian. We agree that, in the event that the Minor shall require emergency medical attention or treatment of any nature in the course of the Ride, the Temporary Guardian may decide on the Minor’s and on our behalf whether to provide such attention or treatment to the Minor. We hereby release the Ride Affiliates from any liability for any injury or death caused as a result of the Temporary Guardian’s decisions hereunder, as more specifically set forth in Section 3 above.
IN WITNESS WHEREOF, the undersigned, intending to be legally bound, have signed this Release and Appointment of Temporary Guardian on this ___ day of ________________, 20___.
Parents:
Signature: _________________________
Name: _________________________
Telephone(s): _________________________
Minor: I have read the above and agree to act as stated above.
Signature: _________________________
Name: _________________________
Signature: _________________________
Name: _________________________
Telephone(s): _________________________
Temporary Guardian: I agree to serve as Temporary Guardian as set forth above.
Signature: _________________________
Name: _________________________