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BLANK
WAIVER AND RELEASE OF LIABILITY
 [Read before Signing]
 BY SIGNING THIS DOCUMENT, YOU ASSUME ALL RISKS AND WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

NAME OF PARTICIPANT: ________________________________ AGE: ______

DATE OF BIRTH_____/_____/_____
PHONE:_______________________
HOME ADDRESS:_________________________________________________
CITY______________________________, STATE:______ ZIP_____________
Warning of Risk
In consideration for use of the services, facilities or equipment on said premises, the Participant hereby releases BLANK, its lessors, its subsidiaries, affiliates, partners, officers, directors, employees, agents and volunteers (and each of their respective heirs, assigns and legal representatives) on behalf of the Participant or his or her heirs, assigns and legal representatives, from any and all liability for negligence, bodily injuries, death or property damage to Participant arising out of the Participant's use of or presence upon the property of the BLANK facilities ("Park" or "Facilities").

The Participant at BLANK, understands, acknowledges, and agrees that skateboarding, skating, BMX biking, and scooter (razor type) riding are Dangerous Activities.  Those Activities can result in injury to the person or Damage to the Property or to Third Parties and the Participant is fully aware of the risks inherent in engaging in or observing any Activities at BLANK.

No matter how careful the Participants and staff are, no matter what safety equipment is worn, the risk of injury or death cannot be eliminated from Participants or Spectators.

The risk of injury includes but is not limited to injuries such as cuts, scrapes, bruises, muscle pulls, broken bones, and dislocations.  The risks include catastrophic injuries such as permanent paralysis or death from landings or falls on the back, neck, or head.  The Participants may suffer such injuries while merely observing or being in proximity to Park Activities as other Participants may collide, land or fall upon you.  The Participant is aware of the conditions of the Park and that conditions may become more dangerous during the time that the Participant is using the premises.  The Participant and Spectator voluntarily assume all risk of loss, damage, or injury while on the premises.  The Participant acknowledges that there are various degrees of skill and experience required for the different activities and the Participant will buy abide by the Rules for use of the various Park Activities, including of wearing all the protective gear and equipment that is required for the Participant and will follow the instructions of Staff members.  Failure to follow rules and instructions from staff may result in termination of participation in activities without refund.

The Participant agrees to indemnify BLANK against and save it harmless from any and all damages, actions, claims, judgments, cost of litigation and attorney fees which may result from the Participant's use of, or presence upon, the property or Facilities of BLANK, including damage to the equipment of BLANK and lessor's property.

I hereby authorize the staff at BLANK to act for me according to their best judgment in any emergency requiring medical attention.  All medical expenses incurred will be the responsibility of the Participant or the Participant's family.  I certify to BLANK, that I have no physical conditions or mental impairment that would be effected by the participation in the activities of BLANK.

I permit BLANK to use any photographs, videotapes, motion pictures, recordings or any other records taken while I am on the premises of BLANK engaged in any activity or event sponsored, promoted, or organized by BLANK for publicity, advertising, or any legitimate purposes.

I agree that this Agreement shall apply to my participation in any and all BLANK activities and programs, including, but not limited to open skating, skateboarding practice sessions, instructional sessions, competitions, and activities directed by any representative of BLANK.  This Agreement shall apply to all my future visits to BLANK.

BLANK and YSCA are committed to conducting their programs in a safe manner and holds the safety of each participant in high regard.  We insist that all participants follow safe skating and biking practices at all times.  A helmet must be worn and securely buckled while skating and biking with no exceptions.  You are solely responsible for determining if you or your minor child/ ward are physically fit and or adequately skilled for the activities contemplated by this agreement.  It is always advisable, especially if the participant is disabled in any way or recently suffered an illness, injury, or impairment, to consult a physician before undertaking any physical activity.

Additional Warning of Risk
Skateboarding, Inline skating, BMX biking, and riding  scooters (razor type) are activities that challenge and engage the physical, mental, and emotional resources of each participant.  However, despite careful and proper preparation, instructions, medical advice, conditioning, and equipment there is still risk of serious injury or death.  Understandably, not all hazards and dangers can be foreseen.  Because these sports are done with little or no protective equipment and because it puts great demands on stamina, the very nature of them is hazardous.  Such risks and dangers include but are not limited to; an irregular riding surface, losing balance, trying to perform stunts, slipping on riding surface, tripping, riding near traffic, loss of control, colliding with other riders or stationary objects, bad weather, lack of or failure of equipment.  It must be recognized that it is impossible for BLANK or its staff to guarantee absolute safety.

As a spectator, there are risks involved.  There is a risk of being struck by a flying object, such as a skateboard, part of a skateboard, any flying object, or an out of control or irresponsible rider, skater, or biker.  Spectators must sign a liability waver to be in or near the skating area.

I have read the above statement, recognize, and acknowledge that there are risks of physical injury to participants and spectators of this program.  I voluntarily agree to assume the risk of any injuries, damages, or loss, regardless of severity that my minor Child/ward or I may sustain as a result of being a spectator and/or participating in the activities connected with or associated with this program/activity.

I do hereby fully release and forever discharge all parties from any and all claims for injuries, damages, or loss that may accrue to my minor child/ward or me and arising out of, connected with, or in any way associated with this program/activity.

I have read and fully understand the above important information and warning of risk statements.  I have also read the above and explained it to my minor child/ward.  I do hereby release all parties from any liability arising out of, or connected to this program.   

BY SIGNING THIS WAIVER AND ASSUMPTION OF RISK AND RELEASE, I ACKNOWLEDGE ITS CONTENTS.  I AGREE TO BE BOUND BY THE TERMS OF THE RELEASE AND UNDERSTAND THAT ANY AND ALL RISKS, WHETHER KNOWN OR UNKNOWN, ARE EXPRESSLY WAIVED IN ADVANCE.  I CERTIFY THAT MY PARTICIPATION IS COVERED BY INSURANCE TO COVER ANY INJURY OR DAMAGES I MAY SUFFER OR CAUSE, OR ELSE I AGREE TO BEAR THE COSTS FOR SUCH INJURY OR DAMAGE TO OTHERS OR MYSELF.  I HAVE SIGNED THIS DOCUMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 

Participant's Signature ______________________________

Age:  _______ Date Signed: _________________________

Emergency Phone numbers -- All numbers will be verified.
We must have two emergency phone numbers before we can allow any one to skate.

Home phone#                                                            _     

First Emergency Phone # ____________________________

Second phone for emergency #                                        _

Pager or Cell phone number                                               

Is the Participant taking any medication?                             

Please list any allergies or medical problems we may need to know about in case of emergency.

PARTICIPANTS AND SPECTATORS UNDER AGE 18 AT THE TIME OF REGISTRATION MUST ALSO HAVE A PARENT OR LEGAL GUARDIAN SIGN BELOW.

This is to certify that I, as parent/guardian with legal responsibility for this Participant OR Spectator, do consent and agree to his/her release as provided above.  I release and agree to indemnify BLANK from any and all liabilities incident to my minor child's involvement or participation in the programs provided above, even IF ARISING FROM THE NEGLIGENCE OF BLANK, to the fullest extent permitted by the law.

___________________________
Parent/Guardian's Signature

Date Signed _________________          

SAFETY GEAR

You must ALWAYS wear a helmet, kneepads, and elbow pads when skateboarding, skating or riding at BLANK Skate Park.

1. A HELMET helps prevent injury to all areas of the head.  Helmets must be buckled and fit properly.  Helmets should be approved by any well-known organization (like the Pro-Tec model). 

2. KNEEPADS are used as the first point of dispersion for impact forces during a fall, a skater should first drop to their knees.  Pads must be securely, strapped around the leg to avoid coming off while sliding. 

3. ELBOW PADS can give protection in backwards and sideways falls.

4. WRIST GUARDS are mandatory for skateboarders and skaters 12 years of age and under in addition to their helmets, kneepads, and elbow pads.  We highly suggest wrist guards for everyone because skaters who lose their balance should try to fall forward.  Wrist guard protection promotes sliding, thereby distributing the impact of the fall.

5.  TAIL BONE AND HIP PADS are optional.  However, we suggest everyone gets and wears a pair of "Crash Pads Pro Pant with Tail Shield."

6. All equipment should be designed for your particular sport, in good condition, and worn properly.