Florida Motorcycle Training, Inc.
Registration Application
 

Name: ________________________________

Age:_______

 

(as on Driver's License)

 

 

Address:______________________________

City: ________________

State:_____

Zip:_________

County:______________

Telephone:_________________

Driver's License #:____________________________________

 Waiver of Release of Liability - Please Read Carefully

In consideration of Florida Motorcycle Training, Inc., furnishing services and/or equipment to enable me to participate in the Motorcycle Rider Education Class, I agree as follows:
 
I fully understand and acknowledge that:  (a) risks and dangers exist in my use of motorcycle equipment and my participation in the Motorcycle Rider Education Class activities;  (b) my participation in such activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability;  (c) these risks and dangers may be caused by the negligence of the owners, employees, officers or agents of Florida Motorcycle Training, Inc., the negligence of the participants, the negligence of others, accidents, breaches of contract, the forces of nature or other causes.  These risks and dangers may arise from foreseeable or unforeseeable causes; and (d) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibilities for any losses and/or damages, whether caused in whole or in part by the negligence or other conduct of the owners, agents, officers, or employees of Florida Motorcycle Training, Inc. or by another other person.
 
I, on behalf of myself, my personal representatives and my heirs hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify Florida Motorcycle Training, Inc. and its owners, agents, officers, and employees from any and all claims, suits or causes of action for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my use of motorcycles and motorcycle equipment or my participation in the Motorcycle Rider Education Class activities.  I specifically understand that I am releasing, discharging and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by Florida Motorcycle Training, Inc. and its owners, agents, officers or employees.
 
I HAVE READ THE ABOVE WAIVER OR RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE FLORIDA MOTORCYCLE TRAINING, INC. FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

_________________________________________
PRINT NAME		 ___________________
DATE OF BIRTH
_________________________________________
SIGNATURE		 ___________________
DATE
_________________________________________
SIGNATURE OF PARENT OR GUARDIAN 
(If under 18 years old)		 ___________________
DATE
 

I am registering for the:           Basic Rider Course ($190)        Experienced Rider Course ($125) 
Police Motorcycle School ($1,000)     Private School ($100/hour with 4-hour minimum) 
Once you are scheduled for a class, the fee is non-refundable.
Please forward completed Registration and Waiver of Release of Liability with check payable to:
Florida Motorcycle Training, Inc.   6954 SW 100 Terrace, Hampton, Florida   32044

Please Do Not Write Below This Line -- For FMT, Inc. Use Only

Check Number:________

Date Application Rcvd: ___________

Student Course Dates: _______________

Confirmed:

Date:___________   Time:_____________

Comments:_________________________________________________________________________________
__________________________________________________________________________________________