Name *

First Name

Last Name

Phone *

(###)

###

####

I understand I must wear a helmet while riding the mobility device. *

Yes

I understand I may be suspended or banned from Zip Club for unsafe or reckless riding. *

Yes

I agree to operate the scooter safely, wear a helmet, and comply with all traffic laws and rules provided by ZIP LLC. *

Yes

I release and hold harmless ZIP LLC, its owners, employees, affiliates, and partners from any liability for injuries, damages, or losses arising from my use of a scooter. *

Yes

I understand I will not give or lend the scooter to anyone who has not completed the official Zip Club member sign-up form. *

Yes

Binding Agreement: This release is binding upon me, my heirs, executors, administrators, and assigns. *

Yes

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone *

(###)

###

####