Name:

DOB:

Email:

Address:

City:

State:

Zipcode:

Home Phone:

Cell Phone:

Spouse Name:

Spouse DOB:

Spouse Email:

Spouse Cell Phone:

1st Child's Name:

1st Child's DOB:

1st Child's Gender:

2nd Child's Name:

2nd Child's DOB:

2nd Child's Gender:

3rd Child's Name:

3rd Child's DOB:

3rd Child's Gender:

1st ATV:    Year

                Make

                Model

                Plate #

                Expiration Date

2nd ATV:    Year

                Make

                Model

                Plate #

                Expiration Date

3rd ATV:    Year

                Make

                Model

                Plate #

                Expiration Date

Insurance Carrier Name:

Insurance Policy Number:

Insurance Policy Expiration Date:

List any special skills:

List other clubs you belong to:

Emergency Contact:

Emergency Contact Phone:

Membership Fee:

New Family Membership ($45)
New Single Membership ($35)
Family Renewal ($35)
Single Renewal ($25)

ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, HOLD-HARMLESS AND INDEMNITY AGREEMENT

In exchange for participating in the activities and events of the “Club” and NYSORVA, and,
also in exchange for being permitted to operate off-highway recreational vehicles (“ORVs”) upon designated trails and areas located on property of landowners whose permission has been
obtained by the club and NYSORVA, for one year from the date of this application and
waiver, I understand and agree as follows:

Acknowledgement and Assumption of Risk: I understand and acknowledge the
risk of accident or injury to my person or property and to others while riding
ORVs. I accept and assume all risks and dangers and all responsibility for any
such accident or injury no matter how, or by whom, it may be caused.

Release, Waiver, Hold-Harmless and Indemnity: To the fullest extent permissible by law,
I hereby release, waive, discharge and covenant not to sue the Club, NYSORVA and the
landowners, from all liability, and further agree to indemnify and hold them harmless for
accident or injury whether caused by the negligence of the Club, NYSORVA and the
landowners, or otherwise.

I HAVE READ THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY,
HOLD-HARMLESS AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS,
UNDERSTAND THAT I MAY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND
HAVE SIGNED IT, ON BEHALF OF MYSELF AND MY MINOR CHILDREN, FREELY AND
VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE
TO ME AND FULLY INTEND MY SIGNATURE TO BE A COMPLETE, CONTINUING AND
UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE FULLEST EXTENT ALLOWED BY LAW.

I acknowledge that I have read and accepted the Assumption of Risk, Release and
Waiver of Liability, Hold-Harmless and Indeminity Agreement between myself and the Club, NYSORVA and the landowners.

Name:

Date:

Name:

Date:

CLUB CODE OF ETHICS

- I recognize that people will judge all motorized trail users by my actions.
- I will ride only on designated, signed or mapped trails and areas.
- I will respect and preserve the public and private property that I ride on.
- I will slow down, use caution and be courteous when I encounter other trail users.
- I will ensure my equipment meets New YorkState safety, insurance, registration,
emission and noise standards.
- I will not endanger myself and other trail users by riding beyond my ability or while
impaired by drugs or alcohol.
- I will not attempt to disturb or directly pursue wildlife with my recreational vehicle.
- I will not construct jumps or obstacles anywhere on the trail or riding areas.

Club membership may be terminated at any time by a vote of the club Board of
Directors. Just cause for termination includes but is not limited to failure to abide
by club’s code of ethics. All memberships expire on April 30 each year.