6/15/2019 Burlington PD-Down Home Harley Davidson Rider Skills Day Registration

BikeSafe-North Carolina invites motorcyclists to participate in Rider Skills Days that offer assessment on present skills, and advice to help make their riding in North Carolina safer and more enjoyable. The Rider Skills Days are run during the week and at weekends, by highly qualified police motorcyclists passing on their wealth of knowledge and experience in a friendly and informal manner.

Class Description Agenda Requirements
  • Status: 3 seats available
  • Location: Burlington PD-Down Home Harley Davidson (Google Map)
  • Address: DOWN HOME HARLEY DAVIDSON, 2215 Hanford Rd, Burlington, NC 27215
  • Host Agency: Burlington Police Department
  • Date: Saturday June 15, 2019
  • Start Time: 8:45 AM sharp
  • Registration Deadline: Thursday June 13, 2019

Registration Form

*All Fields Required

Contact Information


Email Address


Confirm Email


First Name


M. Initial


Last Name


Street Address


City


State


Zip


Phone


Alt. Phone

Motorcycle & Driving Information


Birth Date


Drivers License #


Motorcycle Lic. Plate


Year/Make/Model


Insurance Company


Policy Number


Formal Training

Additional Information

I am signing up at the direction of the court system.

INSURANCE WAIVER PART I. READ CAREFULLY: THIS SECTION IS A LEGAL RELEASE, ASSUMPTION OF RISK, WAIVER AND COVENANT NOT TO SUE AGREEMENT

Insurance Waiver Part I Text:

In consideration of The North Carolina State Highway Patrol and BikeSafe North Carolina, including their members, employees, officers and/or agents (the 'Safety Assessment Providers'), furnishing services, equipment, and/or curriculum to enable me to participate in the BikeSafe North Carolina assessment, I agree as follows:

I fully understand and acknowledge that: (a) there are DANGERS AND RISK OF INJURY, DAMAGE, OR DEATH that exist in my use of motorcycles and motorcycle equipment and my participation in the BikeSafe North Carolina assessment 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, other ailments that could cause serious disability, or death; (c) these risks and dangers may be caused by the negligence of the Safety Course Providers; the negligence of others, including other BikeSafe North Carolina assessment participants; and may arise from foreseeable or unforeseeable causes; and (d) by participating in these activities and/or using the equipment, I, on behalf of myself, my personal representatives and my heirs, hereby assume all risks and all responsibility, and agree to release the BikeSafe North Carolina assessment Providers for any injuries, losses and/or damages, including those caused solely or in part by the negligence of the BikeSafe North Carolina assessment Providers, or any other person. If I have brought a motorcycle to use in the BikeSafe North Carolina assessment, I also agree that this release applies to any damage that occurs to it during the BikeSafe North Carolina assessment.

I agree and understand that, on behalf of myself, my personal representatives and my heirs, I am relinquishing any and all rights I now have or may have in the future to sue the BikeSafe North Carolina assessment Providers for any and all injury, damage, or death I may suffer arising from motorcycle riding or its equipment, including claims based on the Safety Course Providers' negligence.

I HAVE READ THIS RELEASE AGREEMENT AND BY SIGNING BELOW I AGREE IT IS MY INTENTION TO ASSUME ALL RISKS AND RELEASE THE BIKESAFE NORTH CAROLINA AND THE NORTH CAROLINA STATE HIGHWAY PATROL FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

I have had the opportunity to ask any and all questions about the above waiver and release and I understand its terms and meaning.

I assume all risks and waive my right to sue.

INSURANCE WAIVER PART II. READ CAREFULLY: THIS SECTION IS AN INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

Insurance Waiver Part II Text:

In consideration of The North Carolina State Highway Patrol and BikeSafe North Carolina, including their members, employees, officers and/or agents (the 'Safety Assessment Providers'), furnishing services, equipment, I agree as follows:

I, on behalf of myself, my personal representatives and my heirs, agree to hold harmless, defend, and indemnify the Safety Assessment Providers from any and all claims, suits, or causes of action by others for bodily injury, property damage, or other damages which may arise out of my use of motorcycles and motorcycle equipment or my participation in the BikeSafe North Carolina activities, including claims arising from the Safety Assessment Providers' or any other party's negligence.

I HAVE READ THIS INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND BY SIGNING BELOW I AGREE IT IS MY INTENTION TO ACCEPT LEGAL RESPONSIBILITY AND PAY FOR ANY LOSS FOR CLAIMS OR LAWSUITS AGAINST THE NORTH CAROLINA STATE Highway Patrol AND BIKESAFE NORTH CAROLINA ARISING FROM MY PARTICIPATION IN THE MOTORCYCLE ASSESSMENT.

I have had the opportunity to ask any and all questions about this indemnification and hold harmless section and I understand its terms and meaning.

I agree to indemnify and hold harmless all agencies associated with BikeSafe NC.

Emergency Contact Information


First Name


M. Initial


Last Name


Street Address


City


State


Zip


Phone


Alt. Phone