Request Form

Brand: Wipeout

Color: Black

Size: Ages 5+ (fits head circumference 49-52 cm)

Donation Waiver and Release of Liability

I, the undersigned recipient and parent/guardian of the minor child(ren) for whom I am requesting this helmet, acknowledge and agree as follows in connection with my receipt of the donated helmet(s):

1. As-Is Condition

   I understand that the helmet(s) are donated in as-is condition, with no warranties, express or implied, including but not limited to warranties of safety, merchantability, or fitness for a particular purpose.

2. No Representations by Donor

   I acknowledge that any product descriptions, labels, or information I have reviewed about the helmet(s) are based solely on statements made by the helmet’s manufacturer, retailer, or seller. I further acknowledge that Dolezal Law, P.A., its attorney(s), and its respective officers, directors, employees, agents, administrators, volunteers, affiliates, representatives, successors, and assigns (hereinafter "donor") do not have any personal knowledge regarding the condition, make, model, effectiveness, or safety of the helmet(s), and makes no independent representations or guarantees about them.

3. No Safety Guarantee

   I understand that the donor makes no representation that the helmet(s) meet current safety standards or will provide protection from injury. I further understand that the donor has not personally inspected the helmet(s) and understand that it is solely my responsibility to fully inspect the product for defects and proper fit prior to use.

4. Assumption of Risk

   I acknowledge and accept that use of the helmet(s) carries inherent risks of injury, death, or property damage. I voluntarily assume all risks of my own use of the helmet(s) and the use by my minor child(ren).

5. Release of Liability

   To the fullest extent permitted by Florida law, I, on behalf of myself, my heirs, assigns, and my minor child(ren), hereby release, waive, and discharge the donor from any and all liability, claims, demands, actions, or causes of action arising out of or related to the use of the helmet(s).

6. Indemnification

   I agree to indemnify and hold harmless the donor from any claims brought by or on behalf of my minor child, or by any third party, arising from use of the helmet(s).

7. Acknowledgment of Understanding

   By signing below, I am acknowledging that I have read this waiver and release, fully understand its terms, and sign it freely and voluntarily. I understand that by signing this document, I am giving up substantial legal rights for myself and my child, including the right to sue the donor.