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Natural History Museum of Utah E-Bike Use Program Assumption of Risk, Release and Indemnification

READ THIS DOCUMENT COMPLETELY BEFORE COMPLETING, INITIALING AND SIGNING BELOW. ITS EFFECT IS TO

RELEASE THE UNIVERSITY OF UTAH, INCLUDING THE NATURAL HISTORY MUSEUM OF UTAH* (the “MUSEUM”)

FROM ANY LIABILITY RESULTING FROM YOUR PARTICIPATION IN THE E- BIKE USE PROGRAM (the “PROGRAM”).

THIS AGREEENT ALSO MAKES YOU RESPONSIBLE FOR THE LOSS OR DAMAGE TO THE BICYCLE EQUIPMENT YOU

BORROW.

User’s full name:

Date of Birth: ________________ Check Applicable: □ Faculty □ Staff

Address:

Phone:

Bicycle Equipment (“Equipment”): Lock, keys (bike and lock), basket, lights

ACKNOWLEDGEMENT - SAFETY

I, the undersigned (hereinafter "User"), acknowledge that I have been advised to wear an approved helmet while

cycling and have been directed to resources for purchasing a helmet economically. I am aware that the use of the

Equipment is subject to any applicable municipal and provincial highway traffic regulations as well as University

Policy 3-232. I agree to abide by all applicable laws and rules. I agree that I am solely responsible and will not

hold the University of Utah liable for any fines incurred by me for violations while riding the Equipment. I am

familiar with the proper use of the Equipment, including all quick release mechanisms, brakes and gear shifters. I

am aware that there are individuals associated with the Program who are available to answer any questions that I

may have as to the proper use of the Equipment. Initial in box.

ASSUMPTION OF RISKS

I am aware that cycling activities involve many risks, dangers and hazards including, but not limited to:

changing weather conditions; mechanical failure of the bicycle; loss of balance; difficulty or inability to control

one’s speed and direction; variation or steepness in terrain; variation or changes in the cycling surface

including holes or depressions in the roads, dirt, gravel or other objects that may be deposited on the road;

exposed rock, snow, ice, earth, trees, and other natural objects on or adjacent to roads; encounters with

wildlife; collision with pedestrians, vehicles or other cyclists; and, failure to cycle safely or within one's own

ability or within designated areas. I am also aware that the risks, dangers and hazards referred to above exist

throughout the area used for cycling and that many are unmarked. Initial in box.

By signing this agreement, I acknowledge and agree that I will inspect the equipment listed on this sheet prior to each use so that I am satisfied with its condition. The University of Utah is not the manufacturer of the

Equipment and provides no warranties, express or implied. THERE IS NO WARRANTY OF MERCHANTABILITY OR

FITNESS FOR A PARTICULAR PURPOSE and this Equipment is accepted "AS IS." If I notice any items on the

Equipment that are in need of repair, I will bring this to the attention of greenteam@lists.nhmu.utah.edu Initial in box

With full understanding of the foregoing risks, I, accept for use the Equipment listed on this form, exercising my

own free choice to participate voluntarily in these activities, and promising to take due care during such

participation. I hereby agree to freely and expressly assume and accept any risks and all injury to myself, my

personal property, and any others injured or damaged as a result of my use of this Equipment. I understand that

bicycle protective gear such as helmets and gloves are recommended by the University, but they do not

eliminate the risks of injury in the event of an accident. Initial l in box

Oct. 2018

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RELEASE AND INDEMNIFICATION

I hereby release and discharge the University of Utah, including the Museum, from any and all responsibility

or liability for bodily injuries or damages to personal property, including the Equipment listed on this form, of

myself and any other person. I agree not to make a claim against or sue the University of Utah for injuries or

damages relating to bicycling or the use of this Equipment. Initial in box

Further, to the fullest extent allowed by law, I hereby indemnify and hold harmless, the University of Utah and

its trustees, officers, agents, employees, and any other persons or entitles acting on their behalf, and the

successors and assigns for any and all of the aforementioned persons and entities, against any and all claims,

demands, and causes of action whatsoever, whether presently known or unknown, of any person who suffers

any Injury, disability, death or other harm, to person or property or both, as a result of my participation in the

Bicycle Use Program and use of the Equipment. Initial in box

RESPONSIBILITY FOR DAMAGE

The equipment at all times, remains the exclusive property of the University of Utah. I will not attempt repairs or

removal of bike parts held by screws or nuts (saddle adjustments excluded). Needed repairs are to be done by a

bicycle repair specialist and coordinated through the Program.

I acknowledge that I am responsible for damage to or loss of the Equipment. I will properly secure the Equipment

with a lock when I am not using the Equipment. If the Equipment is stolen, lost, destroyed or damaged beyond

repair in the judgment of the Program, I agree to pay the University of Utah the full replacement value of the

bicycle. All repairs needed as a result of the use of the Equipment will be performed at the normal labor rates

and the cost of such repairs, including all parts, shall be paid by me.

Initial in box

* Natural History Museum of Utah a/k/a/ Utah Museum of Natural History

I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read

them, understand them fully, and agree to be bound by them. After careful deliberation, I voluntarily give my

consent and agree to all the terms and conditions set forth above.

___________________________________ Dated: _______________

Signature of User

Oct. 2018

Users full name: Date of Birth: Faculty: OffStaff: OffAddress: Phone: Safety: Assumption of Risk 1: Assumption of Risk 2: Assumption of Risk 3: Release and Indem 1: Release and Indem 2: Damage: Date is not in digi-sign: