Mass Motorcycle School, LLC, Motorcycle Safety Course Waiver of Release of Liability

Waiver 1 and 2 must be completed, signed, and given to your instructor prior to the beginning of your on-cycle instruction.

Participants under the age of 18 years must have the signed approval of a parent or legal guardian to enroll in this motorcycle

safety course. (Sign on waiver 2)

NAME:_______________________________________________________________________________________

ADDRESS:____________________________________________________________________________________

City, _______________________________________________State,____________ Zip______________________               

PHONE: (_______)___________________________________________

DATE OF BIRTH: ___________________________________________

DRIVERS LICENSE NUMBER: __________________________ STATE OF:_______________________________

PLEASE ANSWER THE FOLLOWING QUESTIONS:

 #1. DO YOU HAVE ANY SPECIAL NEEDS?

Briefly describe below any medication you are taking, or any hearing, visual, physical, or reading impairment you may have, that might affect your ability

to learn in the classroom or to control a motorcycle. This information will not prevent you from taking the course, but will help your instructors to provide

you with the best learning experience. If you have no special needs, please write "NONE" below.

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 #2. EMERGENCY CONTACT?

NAME:_______________________________________________________________________________________

RELATION:___________________________________________________________________________________

PHONE:______________________________________________________________________________________

NOTE: Upon successful completion of your class, you have 90 days to get a valid MC permit, pay your license fee and ensure you have no outstanding

debts with the RMV and your license should be issued and received within 21 days. If not, send an email to info@massmcs.com and we will follow up. READ and INITIAL__________________