Connecticut Rider Education Program
Waiver & Release of Liability–Minors
Return this form to Continuing Education Motorcycle Registration, Manchester Community College, Great Path, M.S. #16, P.O. Box 1046,
Manchester, CT 06045-1046
Acknowledgement of Potentially Dangerous Activity
I [and my parent/guardian] understand and am aware that participation in the motorcycle rider education course sponsored by the State of
Connecticut is a potentially hazardous activity. I also understand that this participation involves a risk of injury and even death and that I am
voluntarily participating in these activities and using equipment and/or machinery with knowledge of the dangers involved. Examples of the
inherent risks involved are:
I may forget how to brake or otherwise slow or stop the bike when I need to; I may accelerate without intending to; the bike may fall on me or
otherwise strike me; another participant or his/her bike may hit me; I may panic and not do what I was instructed to do.
These risks and dangers may result due to no one’s negligence or be caused by my own actions or the actions of other participants. It is further
acknowledged that there may be risks and dangers not known to us or that are not reasonably foreseeable at this time.
(Participant, initial _____) (Parent/legal guardian must also initial _____)
Personal Responsibility
I am voluntarily participating in the motorcycle rider education course. I agree to use due care and common sense when participating in this
course and performing these activities. I agree to let the instructor/person in charge know if I see or feel that something is dangerous or that
I am not able to safely do something. While an instructor may encourage me to attempt an activity, I understand that I am best able to judge
whether I can do it safely. I should refuse to do an activity if I feel I cannot do it safely, even if it means that I cannot complete the course and will
not receive reimbursement of the registration fee. The program strongly suggests that I obtain my own private insurance to cover any injuries I
may sustain. (Participant, initial _____) As the parent/legal guardian, I acknowledge that my minor understands this. (Parent/legal guardian
must also initial _____)
Release of Liability
I waive any and all liability for and cause of action for personal injury, property damage or wrongful death arising from my
[or my minor’s] participation in this activity. I hereby release and agree that I will not to sue the releasees for any and all damage or injury to me
[my minor] or to my property. “Releasees” include the State of Connecticut, the Department of Transportation, the Motorcycle Safety Foundation,
the host college, the course instructor, and all of these entities’ officers, agents, employees, representatives, executors or their successors.
(Participant, initial _____) (Parent/legal guardian must also initial _____)
Notice to Participants: Although a fee is charged for this course, it is being offered at low cost and no profit for purposes of promoting safety
and enjoyment of riding. This course is fulfilling a community need by offering a program not easily or otherwise available in the private sector
or only available at higher cost in the private sector.
Minor and Parent/Legal Guardian Must Sign and have read and understand the above paragraphs.
Parent/Legal Guardian Name MI Last Name
Parent/Legal Guardian Signature Date
Minor Participant Name MI Last Name
Minor Participant Signature Date
January 2019/PR