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WAIVER AND RELEASE OF LIABILITYASSUMPTION OF ALL RISKS
AND CONSENT TO USE OF LIKENESS

READ BEFORE SIGNING

By signing below, I agree that:

 

I have voluntarily decided to participate in activities and events at, and use the facilities of, KONA SKATEPARK, which is owned and operated by Kona USA, Inc. (KONA).

I am voluntarily participating with the knowledge of the numerous risks and dangers involved, including but not limited to: physical exertion for which I may not be prepared; consumption of alcoholic beverages; breakdown of equipment, whether rented or owned; accident or illness; the risk of negligence by myself or others, including KONA; and the potential for serious injury, including permanent paralysis or death.

I will follow all written and verbal rules of safety presented to me by KONA.

The enjoyment and excitement of skating is derived in part from the inherent risks associated with an activity that is beyond the generally accepted margins of safety, and that these inherent risks contribute to such enjoyment and excitement, and are one the significant reasons for my participation.

I am responsible for my own welfare and accept any and all risks of unanticipated or anticipated events, illness, injury, emotional or physical trauma or death.

One of the conditions to entering Kona Skatepark and using its facilities is my execution of this Waiver; therefore, as lawful consideration for being permitted to enter Kona Skatepark and use its facilities, I hereby RELEASE AND DISCHARGE FOREVER KONA, ITS SHAREHOLDERS, DIRECTORS, OFFICERS, AGENTS, EMPLOYEES, SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND THE OWNERS AND LESSORS OF PREMISES USED TO CONDUCT A KONA RELATED EVENT (RELEASEES), FROM AND AGAINST ANY AND ALL LIABILITY ARISING FROM MY USE OF KONA SKATEPARK OR PARTICIPATION IN ACTIVITIES OR EVENTS AT KONA SKATEPARK.

This release shall be legally binding upon me personally, all members of my family and all minors accompanying me, my heirs, successors, assigns and legal representatives, it being my intention to fully assume all of the risks associated with my use of Kona Skatepark facilities and to release RELEASEES from any and all liabilities associated with my use of Kona Skatepark facilities to the maximum extent permitted by law.

I understand that KONA reserves the right to refuse admittance to any person who refuses to sign this Waiver or who it judges to be incapable of meeting the rigors and requirements of participation in the activities.

KONA, its agents, successors and/or assigns, reserve the right to take photographic, film, audio or digital records of me using Kona Skatepark facilities or participating in events or activities sponsored by KONA (Kona Media), and I further agree that KONA may use any such Kona Media for promotional and/or commercial purposes, as well as approve such use by third parties with whom KONA may engage in joint marketing, without any remuneration to me. I hereby assign KONA all right, title and interest I may have in or to Kona Media and grant KONA a royalty-free, exclusive, perpetual and irrevocable license to the Kona Media.

I agree that any dispute or claim concerning this Agreement, shall be resolved exclusively by binding arbitration according to the then existing rules of the American Arbitration Association in Jacksonville, Florida. Florida law shall govern this Agreement, excluding any application or consideration of any conflict of laws provisions.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE WAIVER AND OTHER PROVISIONS SET OUT ABOVE.

 

FOR PARTICIPANTS OF MINORITY AGE
(UNDER 18 AT TIME OF SIGNING)

 

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided herein, for myself, my heirs, assigns, and next of kin and any other parent and/or guardian who has placed custody of the above-named minor participant in my care. I further release and agree to indemnify and hold harmless the RELEASEES from any and all liabilities incident to the minor participants use of the Kona Skatepark facilities and/or participation in events or activities at Kona Skatepark, to the fullest extent permitted by law.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE WAIVER AND OTHER PROVISIONS SET OUT ABOVE.

I Testify by signing below that I AM the Parent and/or Legal Guardian for the above named skater.

August 22, 2019

First Skater's Name

First Name*

Last Name*

Phone*
First Skater's Date of Birth*
First Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
First Skater's Signature*
Second Skater's Name

First Name*

Last Name*
Second Skater's Date of Birth*
Second Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Third Skater's Name

First Name*

Last Name*
Third Skater's Date of Birth*
Third Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Fourth Skater's Name

First Name*

Last Name*
Fourth Skater's Date of Birth*
Fourth Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Fifth Skater's Name

First Name*

Last Name*
Fifth Skater's Date of Birth*
Fifth Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Sixth Skater's Name

First Name*

Last Name*
Sixth Skater's Date of Birth*
Sixth Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Seventh Skater's Name

First Name*

Last Name*
Seventh Skater's Date of Birth*
Seventh Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Eighth Skater's Name

First Name*

Last Name*
Eighth Skater's Date of Birth*
Eighth Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Ninth Skater's Name

First Name*

Last Name*
Ninth Skater's Date of Birth*
Ninth Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Tenth Skater's Name

First Name*

Last Name*
Tenth Skater's Date of Birth*
Tenth Skater's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Skater's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Please choose:*
Any medical conditions? (asthma, hemophilia, etc.)*
No
Yes

If yes, please describe.
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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