Office Use Only

Date/Time: Time In: Staff In/Out:_______________/_________

NAME ____________________________________STUDENT ID____________________

ADDRESS_________________________________________________________________
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PHONE________________________EMAIL_____________________________________
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DOB___________________

HOW DID YOU HEAR ABOUT US?

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The following is a warning, release of liability, assumption of risk, and indemnity

agreement between the renting/sharing party (hereinafter referred to as “I”), and the
rental/sharing company (hereinafter collectively referred to as BicyCal).

1. I acknowledge that bicycling can be a hazardous activity that involves risks that may be
injurious or fatal. I agree to assume all risks included in the activity. I acknowledge that
BicyCal requires me to wear a helmet at all times while riding a BicyCal bicycle. BicyCal
provides lights and reflectors and requires users to turn on lights while riding at night as
required by the State of California.

2. I acknowledge that BicyCal is not responsible for the conditions of roads, routes, or
surfaces on which I will be riding a rented bicycle from BicyCal. I acknowledge that flat
tires are an inherent risk of bicycle riding - I further understand that although routes may be
suggested to me for riding BicyCal, the routes are not owned, monitored, managed, or kept
by BicyCal and I therefore release BicyCal from any responsibilities for conditions of said
areas.

3. I agree to indemnify, defend, and hold harmless BicyCal, including owners, officers,
agents, employees, volunteers, participants, landlords, tenants, sponsors, advertisers, The
Regents of the University of California, and any other entity or person acting on their behalf,
from any and all liability for damage, injury, or death to myself, or to any other person or
property, which are in any way connected to my participation in the activity stated herein. I
waive my right to present any legal claim or lawsuit against these entities or persons
regardless of how any damage, injury, or death may have occurred, through negligence or
any other manner considered through legal claim.

4. I agree to release, discharge, indemnify and hold harmless all manufacturers and/or
distributors of any equipment provided to me by BicyCal including but not limited to
bicycles and helmets, from any and all liability for damage, injury, or death to myself, or any
other person or property, which are in any way connected to my participation in the activity
stated herein. I hereby waive my right to present any legal claim or lawsuit against these
entities regardless of how any damage, injury or death may have occurred, through
negligence or any or any other manner considered through legal claim.

5. I agree to confirm receipt of a lock and key before departing BicyCal rental premises with
a rental bicycle/equipment. I acknowledge that it is my responsibility to return said rental
bicycle/equipment under all circumstances, and that BicyCal does not provide pickup/rescue
service. I understand and agree that in the event said rental bicycles/equipment are lost,
stolen or damaged beyond repair, I will be charged the total cost to replace/repair
bicycles/equipment plus any additional charges incurred. I acknowledge that BicyCal
insurance does not cover loss, theft or abuse of rental bicycles/equipment. A fee of $30 will
be charged for loss of lock and/or lock key. Bicycle/equipment damage/loss will be based on
retail replacement costs. Collegiate bicycle/equipment retail cost is $400.

6. I understand and agree that the charge for bicycles that are returned late is calculated based
on 30-minute increments with a 5-minute grace period. I agree that I will be charged $2 per
every 30-minute increment following the 5-minute grace period. If bicycle and/or equipment
is not returned to BicyCal within twenty-four hours from the point in which it was due back,
BicyCal will charge the total cost of the bicycle and equipment as stated above.

7. I agree that this contract is a warning, release of liability, assumption of risk, and
indemnity agreement that serves as a legally binding contract. I agree that this contract is
intended to be as comprehensive a release of liability and indemnity as is legally allowed. I
agree that if any portion of this contract is found to be void, invalid or un-enforceable, the
remaining portions shall remain in full force and effect. I agree that this contract shall be
binding for myself, my children, my heirs, assigns, executors, personal representatives, and
administrators of my and, or their estate(s).

I have read this contract, understand its terms, and agree that signing below binds me to
its contents.

DOB (*Must be over 18 years old*)_____________________________________

Name X________________________________________________________

Signature X________________________________________________________

Date X________________________________________