Full Legal Name
*
First Name
Last Name
Adress
Adress
Street Address Line 2
City
State / Province
Postal / Zip Code
City / State / ZIP
City / State / ZIP
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth :
*
/
Month
/
Day
Year
Date of Birth :
Email
*
Email
Phone
*
Phone
Format: (000) 000-0000.
Initials
*
Emergency Contact - Name
*
Emergency Contact - First Name
Last Name
Emergency Contact - Phone
*
Emergency Contact - Phone
Format: (000) 000-0000.
Media & Image Right
I AGREE to the media release above
I DO NOT AGREE to the media release
Participant declarations - Please initial each box
*
I am 18 years of age or older and I have valid proof of age available upon request.
I have read this entire Agreement carefully and understand its contents.
I understand that I am waiving significant legal rights by signing this document.
I confirm I am in good physical health and able to participate in the SKwheel demonstration.
I voluntarily choose to participate in the SKwheel demonstration knowing the risks involved.
I understand SKwheel is a fully manufactured electric ski product developed and produced by E-LINE SAS.
I agree to follow all safety instructions given by SKwheel staff before and during the demonstration.
I have had the opportunity to ask questions and all my questions have been answered satisfactorily.
I have read Section 5 above and expressly waive the protections of California Civil Code Section 1542.
Signature
*
Date
*
/
Mois
/
Jour
Année
Date
Testing location
*
Pedego Electric Bikes La Jolla
SKwheel Waiver California
Soumettre
Should be Empty: