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SFC Jericho Skatepark

1848 South Ridgewood Ave

South Daytona, FL32119

Phone: 386-761-1123

Skatepark Participant Liability Waiver and Registration

All participants must complete and sign thisWaiver And Release of Liability, Assumption Of All Risks and Consent To Use of Likeness before entering the skatepark.

READ BEFORE SIGNING

1. I have voluntarily decided to participate in activities and events, and use the facilities of, SFC Jericho Skatepark, which is owned and operated by Skateboarders for Christ, LLC, DBA SFC Jericho Skatepark and Stone Edge Properties Inc.

2. 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, breakdown of equipment whether rented or owned, accident or illness, the risk of negligence by myself and/or others, including Skateboarders for Christ, LLC, DBA SFC Jericho Skatepark and Stone Edge Properties Inc, and the potential for serious injury including perpament paralysis or death.

3. I will follow all written and verbal rules presented to me by Skateboarders for Christ, LLC, DBA SFC Jericho Skatepark.

4. The enjoyment and excitement of all action sports 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 of the significant reasons for my participation.

5. 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.

6. One of the conditions to entering SFC Jericho Skatepark and using its facilities is my execution of this waiver, therefore, as lawful consideration for being permitted to enter SFC Jericho Skatepark and use its facilities, I hereby release and discharge forever Skateboarders for Christ, LLC, DBA SFC Jericho Skatepark and Stone Edge Properties Inc, its shareholders, directors, officers, agents, employees, volunteers, sponsoring agencies, sponsors, advertisers, and the owners and lessors of premises used to conduct an SFC Jericho Skatepark related event (releasees), from and against any and all liability arising from my use of SFC Jericho Skatepark or participation in activities or events at SFC Jericho Skatepark.

7. 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 SFC Jericho Skatepark facilities and to release releasees from any and all liabilities associated with my use of SFC Jericho Skatepark facilities to the maximum extent permitted by law.

8. I understand that SFC Jericho Skatepark 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 any or all activities.

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

10. 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 South Daytona, Florida. Florida law shall govern this agreement, excluding any application or consideration of any conflict of laws provisions.

BY SIGNING THIS DOCUMENT, I ACKNOWLEDGE THAT I HAVE UNDERSTOOD AND AGREE TO THE WAIVER AND ALL OTHER PROVISIONS SET FORTH WITHIN.

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
Participant'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.
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
EMERGENCY CONTACT INFORMATION

Name: *

Phone Number: *

Relationship: *

Name:

Phone Number:

Relationship:
A parent or court-appointed legal guardian 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. By signing this document you testify that you are the parent or court-appointed legal guardian for the participating minor. You consent and agree to the participating minor's release as provided herein, for yourself, your heirs, assigns, next of kin and any other parent and/or guardian who has placed custody of the named participating minor in your care. You further release and agree to indemnify and hold harmless the releasees from any and all liabilities incident to the participating minor's use of SFC Jericho Skatepark's facilities and/or participation in events or activities at SFC Jericho Skatepark, to the fullest extent permitted by law.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

PLEASE LIST ALL KNOWN MEDICAL CONDITIONS
PLEASE SELECT THE PARTICIPANTS PREFERRED SPORTS *
SKATEBOARDING
SCOOTERING
BMX
ROLLERBLADING
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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