Wish Rider Motorcycle Tours
                                                                                      Release and Waiver


   I am signing this document of my own free will and represent that I am knowledgeable and aware of the danger and hazards associated with riding motorcycles. I further understand that I am responsible for my own actions and well being during all associated activities that I may participate in. I certify that I am legally licensed and competent to operate a motorcycle in a safe manner, and that the vehicle I use on this tour is in a safe and legal operating condition. I am solely responsible to determine a speed that is safe for the conditions and characteristics of my motorcycle for myself and all others participating in the tour. I fully understand that Dwight P. Moffitt is acting as my agent specifically to obtain lodging and meals during this guide tour, and I hereby release and hold harmless Dwight P. Moffitt , Wish Rider Motorcycle Tours and any staff or persons associated  with Wish Rider Motorcycle Tours against any and all claims, causes of action, or any other liability of any kind arising from my activity of touring by motorcycle. I certify that I have no known physical or mental impairment that may affect my safety or the safety of the group. I understand that the choice of wearing a helmet or other protective gear is solely my own and that I am responsible for my compliance with all state laws, including those regarding the use of helmets. I understand that Wish Rider Motorcycle Tours accepts no responsibility for loss of or damage to any of my personal belongings including my motorcycle regardless of whether or not it is being trailered. I further certify that I am not under the influence of any narcotic, alcohol, or any other drug that may impair my judgment or understanding and that I will not at any time during the tour operate my motorcycle under the influence of any narcotic, alcohol, or any other drug.


Signature of Rider__________________________________________   Date _______________________
Print Name ___________________________________________________________________________
Drivers License #, State or Province, Country  _________________________________________________
Signature of Co-Rider _________________________________  Date  _____________________________
Print Name  ___________________________________________________________________________
Please Provide the Following Emergency Info:
Emergency Contact Name: _________________________________________
Relation: ______________         Phone (home) ______________________  (work)  ____________________
Vehicle Insurance Carrier: _________________________________ Policy#  _________________________
Health Insurance Carrier (rider) ____________________________   Policy#  _________________________
Health Insurance Carrier (passenger) _________________________ Policy# _________________________

Please List Any Allergies,  Medical Conditions or Medicines taken Regularly:
_____________________________________________________________________________________
Do you carry medication for insect or bee stings? If so what: _______________________________________

All riders or riders/ passengers must complete and submit this form prior to participating in our tours. Please send to the following address along with any deposits and registration form.

                                                                       Wish Rider Motorcycle Tours
                                                                              376 Tallwood Circle
                                                                        Londonderry, Vermont 05148