HEROES HIGHWAY RIDE & RALLY
Please Print Clearly
Riders Name: __________________________________________
Passengers Name: _______________________________________
City: ______________________________ Province/State: _______
Postal Code: ____________ Phone: _________________________
License Plate #: _____________________ Province/State: _______
WAIVER IN CONSIDERATION of acceptance of my application and the permission to participate as an entrant in the Heroes
Highway Ride. I, myself, my heirs, executors, administrators, successors, assigns, assumes all risks and dangers and DO HEREBY
RELEASE, WAIVE AND FOREVER DISCHARGE Lou DeVuono, the Board of Directors of the Heroes Highway Ride & Rally
Association, the Perfect Pigs M.C., the Ministry of Defence, Canadian Forces Base Trenton, the Province of Ontario, the
participating Municipalities, Ontario Provincial Police, local police forces (regular and auxiliary), the Commissioner and Chiefs of
Police, other Associations, local charities, volunteers, sanctioning bodies and sponsoring companies and all of their respective
agents, officials, officers, directors, partners, employees, shareholders, association members, servants, contractors, representatives,
elected and appointed officials, successors, assigns, heirs, executors, and administrators where applicable OF AND FROM ALL
claims, demands, damages, costs, expenses, actions, causes of actions, suits, depts.., duties, accounts, bonds, warranties,
indemnities, claims over, contract and liabilities, whether in law or equity, in respect of death, injury, loss or damage to my person
or property HOWSOEVER CAUSED, arising or which may arise by reason of my participation in said event, whether AND
NOTWITHSTANDING that the same may have been caused by or contributed to or occasioned by negligence of the aforesaid. I
FURTHER UNDERTAKE to HOLD AND SAVE HARMLESS AND AGREE TO INDEMNIFY all of the aforesaid from and against
any and all liability incurred by any or all of them arising as a result of, or in any way connected with my participation in the said
event. BY SUBMITTING THIS ENTRY, I ACKNOWLEDGE HAVING READ, UNDERSTOOD AND AGREED to the above
WAIVER, RELEASE AND INDEMNITY. I WARRANT that I am physically fit to participate in this event and that I am 18 years of
age or older and currently hold a valid license and valid vehicle insurance as required by Ontario law.
I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on video, digital camera and/or
other electronic means without payment or any other consideration. I understand that my image may be edited, copied, exhibited,
published or distributed and hereby waive the right to inspect or approve the finished product wherein my likeness appears.
Additionally, I waive any right to royalties or other compensation arising or related to the use of my image and/or recording.
Additionally, by signing this release I understand this permission signifies that photographic or video recordings of me may be
electronically displayed via the Internet and/or in a public setting.
By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound
thereby. I hereby release any and all claims against any person or organization utilizing this material.
Riders Signature: _____________________________________ Date: _________________
Passengers Signature or Guardian (if applicable): ________________________________