Please fill in a valid value for all required fields
Please ensure all values are in a proper format.
Are you sure you want to leave this form and resume later?
Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.
Save and Resume Later
Save and get link
You must upload one of the following file types for the selected field:
There was an error displaying the form. Please copy and paste the embed code again.
Apply Discount
You saved
with code
Submit
Submitting
Validating
There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.
Please check the field:
Fields
Indian Motorcycle Demo Waiver
Please fill out your information below to register for this event.
Name
*
First Name
*
Last Name
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
State
ZIP Code
Phone
Email
*
Do you have a valid Motorcycle Endorsement
*
Yes
No
Passenger
Drivers Licence Number
*
Drivers Licence Expiration Date
*
Date of Birth
*
What do you currently ride?
*
Indian Motorcycle
Victory
BMW
Honda
Harley-Davidson
Kawasaki
Suzuki
Triumph
Yamaha
Other
Voluntary Waiver, Consent, Release, and Hold Harmless Agreement PLEASE READ THIS AGREEMENT CAREFULLY. DO NOT SIGN THIS AGREEMENT UNLESS YOU AGREE TO THESE TERMS. RIDING IS VOLUNTARY, YOU ARE NOT REQUIRED TO PARTICIPATE. 1. In consideration for being allowed to participate in a Motorcycle demonstration ride or focus group on the date of my signature below (the “Event”), I agree to assume all risks, waive all claims, release all liability, and defend and hold Polaris, its dealers, and other Event Sponsors harmless to the fullest extent allowed by law. 1. I ACKNOWLEDGE AND AGREE THAT: a. I have a valid driver’s license and motorcycle endorsement, and I can legally operate a Motorcycle vehicle as part of the Event. a. I have reviewed, am familiar with, and will comply at all times with the safety instructions provided by the Event Sponsors, ALL INSTRUCTIONS AND WARNINGS contained in the Owner’s Manual, and the warnings on the vehicles, including the use of a helmet and other personal protective equipment. I have not and will not consume alcohol or any other substance that could impair my judgment or driving ability. If I have any questions, I will ask before riding. a. I am aware of and voluntarily assume the risks associated with MOTORCYCLES AND THREE-WHEELED VEHICLES, including serious injury and/or death caused by loss of vehicle control, collisions, mechanical failures, road and/or riding conditions, my own negligent acts, the negligent acts of other riders, and the potential negligence of Event Sponsors, including the failure to adequately screen, train, warn, or otherwise protect me from all these risks. 1. I AGREE TO WAIVE TO THE FULLEST EXTENT ALLOWED BY LAW ANY AND ALL CLAIMS OF ANY KIND that I have or may in the future have relating to the Event, whether directly or by subrogation or otherwise, against Polaris Industries Inc. (“Polaris”), any participating Polaris dealership(s), industry association(s), or other event sponsor(s), and/or any of their affiliates, employees, agents, successors or assigns, (collectively, “Event Sponsors”). I also understand that while the Event may include insurance category Event Sponsors, such sponsorships DO NOT result in any obligations for such Event Sponsors to insure any riders participating in the Event. 1. I AGREE TO RELEASE THE EVENT SPONSORS FROM ANY AND ALL LIABILITY for any loss, damage, expense or injury (including death) that I or my next of kin may incur resulting from my participation in the Event. I understand that this waiver and release do not extend to intentionally wrongful acts on the part of the Event Sponsors. 1. I expressly waive any benefits I may have under Section 1542 of the California Code, or any other law, that provides that a general release does not extend to claims which I do not know of or suspect exist, which if known by me may have materially affected my decision to sign this agreement. 1. I AGREE TO DEFEND, HOLD HARMLESS, AND INDEMNIFY THE EVENT SPONSORS from and against any and all liability for any claim or loss, including personal injury, death, property loss, attorney fees, and litigation costs resulting from my participation in the Event. 1. I HEREBY GRANT to the Event Sponsors, and those acting with their authority, the unrestricted, perpetual, worldwide right and license to use my name, photograph, likeness, voice and biographical information, and any photograph, video or audio tape that may be taken of me or that includes such materials without further compensation or notice to or permission from me or any third party. 1. THIS AGREEMENT SHALL BE GOVERNED BY MINNESOTA LAW, without regard to its choice of law rules. Any dispute or claim relating to this Agreement or the Event shall be finally resolved by binding arbitration under the United States Arbitration Act in the state of Minnesota. I HAVE READ THIS AGREEMENT CAREFULLY PRIOR TO SIGNING IT. I UNDERSTAND THAT I AM WAIVING CERTAIN LEGAL RIGHTS BY SIGNING THIS AGREEMENT
*
[clear]
Use your mouse or finger to draw your signature above
Previous
←
Next
→
Powered by Formstack
Create your own form
›
Enter your save and resume password
Cancel
Confirm