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WFC Bike Club Consent and Release of Information Form

  1. I assume full responsibility during and after my participation, for my choices to use or apply, at my own risk, any portion of teh information or instruction I receive. In consideration of my participation in the WFC Bike Club, I hereby waive, release and forever discharge the Winona Friendship Center and its' officers, agents, employees, representatives, executives and all others from any and all responsibilities or liability for injuries or damages to me resulting in my participation in the program.
  2. The Winona Friendship requires written permission to distribute personal information such as name, phone number, cell phone number, and email address. The information will only be shared with fellow Bike Club members and will not be given out to any other agencies, organizations or groups. This information will be used to contact Bike Club members with Bike Club information in order to arrange car pools, time and place of rides, and in the event of an emergency (such as a bike break down during a ride).
  3. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  5. This field is not part of the form submission.