waiver page

Waiver and Release Form for Rolling for Homes
All drivers, riders and passengers need to fill out this form. Parents, please sign for minors.

* Indicates required field

Name *

First

Last

Email *

By Signing this waiver, I acknowledge that I am fully aware of the danger(s) and hazards associated with participating in a motorcycle/jeep ride. I certify that I am duly licensed and competent to operate a motorcycle/jeep in a safe and responsible manner and the vehicle is in safe operational condition. I will be riding on public highways in West Greenwich, Exeter, Scituate, Glocester, Smithfield and understand that I am solely responsible to determine the speed and operational characteristics of my vehicle while participating in the run. I hereby release and hold harmless Habitat for Humanity West Bay and Northern Rhode Island and any of its executives or other members, and towns against any and all claims, causes of action, and/or any other liability of any kind arising from my participation and activity affiliated with this run, during this run, and accept full and sole responsibility for my own actions.

I certify the I have no known physical or mental impairment that may affect my safety or the safety of other participants. I understand and acknowledge that the choice of wearing a helmet and/or other protective gear is solely my choice and I am responsible for my compliance with all state laws, including those regarding helmets. I certify that I am not under the influence of any narcotic or other substance that may impair me. I also understand that this Waiver and Release is in force from the date of signature and covers any and all activities with Habitat for Humanity West Bay and Northern Rhode Island and/or this run.

By signing this waiver. You are also responsible for any passenger(s) that may be accompanying you, including any minors. Due to Covid 19, You attest that you have read the symptoms below and declare that you nor your passenger(s) are not currently experiencing any symptoms. It is imperative that if you do, that you notify us at connect@habitatriwestbay.org so that we can implement contact tracing.

Name of Rider, Driver *

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Date: *

Address *

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City

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Zip Code

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Phone Number *

Vehicle Make & Model *

Plate Number *

State *

Name of Passenger or minor *

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Name of Passenger or minor *

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Name of Passenger or minor *

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