ORGANIZATION, EVENT, OR PARK: Orchard Skateshop LLC

In consideration of being allowed to participate in any way in the program, parks, related events, activities, and all other sanctioned parks and events the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury from the activities involved in these programs is significant, including the potential for permanent disability and death , and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury to me does exist; and,

2. I KNOWINGLEY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If I observe any unusual significant concern in my readiness for participation and/or in the program itself, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4. I, for myself and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE SKATEPARK ASSOCIATION OF THE UNITED STATES OF AMERICA and MEMBERS, its officers, officials, agents, an d/or employees, other participants, sanctioned events, sanctioned parks , sanctioned organizations, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property incident to my involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permit ted by law.

5. I, for myself and on behalf of my /our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent of the law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITH OUT ANY INDUCEMENT. I attest that I am physically fit and have been trained for this activity.

I also waive and release the use of my photograph or likeness for any reason or purpose. I WANT TO PARTICIPATE IN THIS HAZARDOUS SPORT!

I AGREE TO ASSUME FULL RESPOINSIBILTY FOR ALL INJURIES AND MEDICAL EXPENSES INCURED WHILE RIDING IN THIS PARK, EVENT OR PROGRAM.

PLEASE FILL OUT ALL REQUIRED FIELDS:

Participant's Name: (required) :
 
Please fill in your phone number (required) :
Please fill in your address (required) :


Please enter date (required) :
/ /

MEDICAL RELEASE : In the event that I cannot be reached in an emergency, I hereby give permission to any licensed physician, surgeon, clinic, or hospital to secure proper treatment, and to order anesthesia, for my child/myself as named above. 

My child/I am allergic to the following medications (write none if none): (required) :
Emergency name & contact: (write none if none) (required) :
Your signature (required) :
Would you like to be added to the email list? Very limited emails for sales and special events only, no spam we promise! (required) :
  •  Yes
  •  No thanks

FOR USERS UNDER 18:

Please have parent complete

Parent or Legal Guardian's Name: :
Your Parent/Legal Guardian's Drivers License State and Number :
Your Parent/Legal Guardian's Signature :

 

SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR. ALL SKATERS / MEDIA MUST HAVE PHOTO I.D. TO ENTER THE SKATEPARK OR EVENT.

 

 

 

 

 

 

Notary Public Seal (please get stamped):                                                          ________

**Unless signed in person with participant, legal guardian, and skatepark official/employee witness, waivers will not be accepted without notary public seal. If a parent/legal guardian with valid ID is present at Orchard at the time of signing, this section is not applicable. Thank you.**

                              

EMPLOYEE USE ONLY:

WITNESS SIGNATURE (Employee Use Only): :