STAR Touring & Riding Assoc.
Motorcycle Ride Waiver and
Release Form
In signing this document, I
represent that I am fully knowledgeable of the danger and hazards associated with
riding motorcycles. I certify that I am duly licensed and competent to operate
a motorcycle in a safe manner and the vehicle is in a sage operating
condition. I will be riding on public
highways and am solely responsible to determine the speed and operational
characteristics of my motorcycle while participating in the tour. I am licensed to operate a motorcycle and
always carry motorcycle liability insurance as required by law. I hereby release and hold harmless STAR Touring and Riding, Superstition
Mountains, AZ. Chapter #347 any of its executives or members, against all
claims, causes of action or any other liability of any kind arising from my
activity of touring by motorcycle.
I certify that I have no
known physical or mental impairment that may affect my safety or the safety of
the group. I understand that the choice of wearing a helmet or other protective
gear is solely my own and that 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, alcohol or other drug that may impair my
understanding or judgment and that I will not, at any time during the tour,
operate my motorcycle under the influence of any narcotic, alcohol or any drug. I
understand that this waiver and release is in force through
Signature:_____________________________________ date: _________________
Print name:____________________________________ phone: H C
W________________
Drivers license number:
_________________________ state:
_______
Vehicle insurance
carrier________________________ policy
#_________________
Email address:__________________________________
Passengers signature:__________________________ Print
passengers name:___________________
The Motorcycle Safety Foundation estimates that only 40%
of motorcycle riders are licensed.
A Chapter officer must verify the Motorcycle Endorsement of each member and guest rider..
Official use only:
motorcycle endorsement
verified: YES___ No ___
Verified by: ______________________________ chapter office: Pres VP Sec Treas__
Witnessed by signature:__________________________
Print witness name:________________________
The following is voluntary and will be used
for emergency purposes only…
Emergency contact name:____________________________ phone (home/work/cell)________________
Relation
_____________________ phone
(home/work/cell)______________________
Health insurance provider –
rider____________________________
policy#_______________
Health insurance
provider-passenger_________________________ policy#_______________
Please list any allergies,
medicines taken regularly or any medical condition on reverse side