Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3Age Verification** I am 18 years of age or older, and understand that anyone under the age of 18 must be accompanied by an adult.NextName *FirstLastDate of Birth *Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEmail *Phone *NextEmergency Contact *I understand my emergency contact must be 18 years or older.Emergency Contact Relationship *FriendSpouseSiblingOtherEmergency Contact Name *FirstLast Address Birth of Emergency Contact Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEmergency Contact Email (optional)Emergency Contact Phone *Terms & Conditions *I release all liability and responsibility.I acknowledge the potential risk of my participation.Pittsboro eBikes Waiver of Liability and Rental Agreement Location: 213 Lorax Lane, Pittsboro, North Carolina 27312 1. Acknowledgment of Risks I, the undersigned (“Renter”), fully understand that the rental, operation, and use of an electric bicycle (“eBike”) or electric scooter (“eScooter”) involves inherent risks. These may include (but are not limited to) collisions with other vehicles, pedestrians, or stationary objects; unexpected road or trail conditions; adverse weather; and potential equipment failures. I recognize that serious injury or death can occur if these risks are not properly managed or if equipment is misused. 2. Assumption of Responsibility I hereby assume full responsibility for my own safety and any consequences arising from my use of the eBike or eScooter. I certify that I am physically and mentally able to safely operate the rented vehicle and agree to abide by all applicable local and state laws (including traffic regulations and helmet requirements). 3. Waiver and Release of Liability In consideration of being allowed to rent and operate an eBike or eScooter from Pittsboro eBikes, I voluntarily agree to the following: Release: I release and discharge Pittsboro eBikes, its owners, employees, agents, and affiliates from any and all liability, claims, demands, actions, and causes of action, including those arising from negligence, which may result in property damage, personal injury, or death arising from or related to my use of the rented vehicle. No Lawsuits: I agree not to bring any claim or legal action against Pittsboro eBikes, its owners, employees, agents, or affiliates for any injury, loss, or harm sustained during my rental period. Indemnification: I agree to indemnify, defend, and hold harmless Pittsboro eBikes from any and all claims, demands, losses, liabilities, damages, actions, or judgments, including costs and attorneys’ fees, that may be incurred in connection with my rental and use of the eBike or eScooter, whether caused by my negligence or otherwise. 4. Rental Terms and Conditions Security Deposit: I acknowledge that a $50 refundable deposit is required for each rental. This deposit will be returned to me at the conclusion of my rental period, provided the vehicle and any rented accessories are returned in the same condition as they were received (normal wear and tear excepted) and on time. Damage or Loss: I understand that if the eBike or eScooter or any provided accessory (including helmets, locks, chargers, etc.) is lost, stolen, or damaged while in my possession, I will be responsible for the full cost of repair or replacement. Pittsboro eBikes reserves the right to use all or part of my deposit to cover such costs. If the repair or replacement cost exceeds the deposit amount, I agree to pay the remaining balance. Safe Operation: I will comply with all traffic laws, signs, signals, and rules of the road, and I agree not to operate the vehicle under the influence of drugs or alcohol. Equipment Check: I acknowledge that I have inspected (or have been given the opportunity to inspect) the rented vehicle for any visible damage or mechanical issues prior to use. I agree to notify Pittsboro eBikes immediately if any issues arise during the rental. Return Policy: I will return the eBike or eScooter and any accessories to Pittsboro eBikes by the agreed-upon date and time, in good working condition. Late returns may incur additional fees. 5. Governing Law This Waiver of Liability and Rental Agreement shall be governed by the laws of the State of North Carolina. Any legal actions or proceedings arising from this agreement shall be brought exclusively in Chatham County, North Carolina. 6. Severability If any provision of this agreement is found to be unenforceable or invalid, that provision shall be limited or eliminated to the minimum extent necessary, so that the remainder of the agreement shall remain in full force and effect. 7. Acknowledgment of Understanding I have read this Waiver of Liability and Rental Agreement in its entirety and understand all its provisions. I am aware that by signing this document, I am waiving substantial legal rights, including the right to sue. I sign it freely and voluntarily, and I intend for this waiver and release to be a complete and unconditional release of liability to the greatest extent allowed by law. Your Signature * Clear Signature Sign Waiver