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2nd Nature 3, Inc.
1 Highland Indust Park Peekskill, NY 10566

This waiver is for you or your son/daughter to skate on our ramp.  If you are under 18 and your parent is not present to sign this waiver you can have them sign it online at:

*WAIVER - PHOTO ID IS REQUIRED *

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A PARK STAFF MEMBER. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS. YOU NEED TO READ ALL OF IT CAREFULLY. NO ADMITTANCE WILL BE GRANTED WITHOUT PROPER REVIEW, COMPLETION AND EXECUTION OF THIS DOCUMENT.

In consideration of being allowed to participate and use, on this date or any future date, the property, facilities and services of 2ND NATURE 3, INC related activities, events and contests, I (the undersigned) acknowledge, appreciate, and agree that:

THE RISK OF INJURY FROM THE ACTIVITIES INVOLVED AT 2ND NATURE 3, INC 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,

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

I willingly agree to comply with the stated and customary terms and conditions for participation. If I observe any unusual significant concernin my readiness for participation at 2ND NATURE 3, INC itself, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

I, for myself and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS 2ND NATURE 3, INC, its officers, officials, agents, and/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 at 2ND NATURE 3, INC, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I UNDERSTAND THAT RAMPS ARE HAZARDOUS BY DESIGN. I will not hold the owners liable for any injury, mishap or death resulting from riding ramps; from skate park design; from skate park construction; from skate park maintenance; spectatorship, or presence at or near 2ND NATURE 3, INC. This includes but is not limited to slipping, tripping, falling, collision with another person or object, impalement or falling objects.

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 at 2ND NATURE 3, INC, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent of the law.

I ACKNOWLEDGE AND AGREE TO ALL POSTED RULES AT 2ND NATURE 3, INC AND I AM AWARE THAT MYSELF OR MY SON / DAUGHTER MAY SKATEBOARD WITHOUT A HELMET AND / OR PADS AND I AGREE TO ASSUME ANY ADDITIONAL RISKS THAT MYSELF OR MY SON / DAUGHTER MAY INCUR BY NOT WEARING A HELMET OR PADS.

*ASSUMPTION OF RISK *

I acknowledge and understand that skateboarding and similar activities are hazardous and dangerous activities that involve strenuous exercise. I acknowledge the risk of injury from the activities involved can be significant, including the potential for permanent paralysis, death and serious bodily injury and damage to property. I acknowledge that my presence or the Participants presence and any participation in activities at 2ND NATURE 3, INC are strictly voluntary and that there is no one forcing me and or the Participant to participate in any activities at 2ND NATURE 3, INC I hereby represent that no special relationship exists between me/the Participant and any of the covered parties and that I am not under any physical, economic or other compulsion to sign this Agreement. On my own behalf and on behalf of the Participant, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my/the Participants participation while on the premises of 2ND NATURE 3, INC I am also aware that there is an inherent risk in simply being at 2ND NATURE 3, INC and/or observing, photographing or videotaping the activities. On my own behalf and on behalf of the Participant, I knowingly and voluntarily assume any and all of the foregoing risks of loss, damage and injury.

I HAVE READ THIS RELEASE OF LIABILITY, THE ASSUMPTION OF RISK AGREEMENT, AND THE SKATE PARK RULES, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I attest that I am physically fit and ready 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 RESPONSIBILITY FOR ALL INJURIES, PERMANENT DISABILITY OR DEATH AND MEDICAL EXPENSES IN CURRED at 2ND NATURE 3, INC

I ACKNOWLEDGE AND AGREE TO ALL RULES AT 2ND NATURE 3, INC AND I AM AWARE THAT MYSELF OR MY SON / DAUGHTER MAY SKATEBOARD WITHOUT A HELMET AND / OR PADS AND I AGREE TO ASSUME ANY ADDITIONAL RISKS THAT MYSELF OR MY SON / DAUGHTER MAY INCUR BY NOT WEARING A HELMET OR PADS.

Date Signed: July 4, 2020

I Agree

 

First Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

First Participant's Signature*
Second Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

Third Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

Fourth Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

Fifth Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

Sixth Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

Seventh Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

Eighth Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

Ninth Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

Tenth Participant's Name

First Name*

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

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

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:


List allergies

DOCTOR to be notified in case of emergency

17 AND UNDER, SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY A SANCTIONED: PARK, EVENT OR ORGANIZATIONS OFFICIAL OR DIRECTOR.

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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