NOTE: Susie's Mopeds does not accept paper waivers, please submit electronically.

PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION

(Must be completed for participants under the age of 18)

In consideration of Minor (listed below) being permitted by SMR to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless SMR from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

Electronic Signature Consent

By checking here, you acknowledge you have read and understand the above terms, and are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

Full Name of Parent/Legal Guardian

Name of Participating Minor(s)

You may list multiple that you are the parent/legal guardian of that are participating.

Age of participating minor(s)

Please list all ages if multiple

Click to Sign

Signature of Parent/Legal Guardian

Wed Apr 2, 2025

NOTE: Susie's Mopeds does not accept paper waivers, please submit electronically.

PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION

(Must be completed for participants under the age of 18)

B. Parents/Guardian minor release form