Loading...

Victory Ride Skatepark D/B/A The BAY - Waiver and Release

MUST BE 18 YEARS OR OLDER TO SIGN. ALL MINORS MUST HAVE A LEGAL

ADULT GUARDIAN SIGN FOR THEM.

 

RECREATIONAL ACTIVITY RELEASE OF LIABILITY, WAIVER OF CLAIMS,

EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT.

Please read and be certain you understand the implications of signing.

EXPRESS ASSUMPTION OF RISK ASSOCIATED WITH RECREATIONAL ACTIVITIES.

I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated

with the recreational activity generally described as skatepark including the rental of equipment and transportation

associated therewith in which I am about to engage. Inherent hazards and risks include but are not limited to:

1. Risk of injury from the activity and equipment utilized is significant including the potential for permanent disability and death.

2. Possible equipment failure and/or malfunction of my own or others equipment.

3. This activity takes place outdoors and therefore includes risks associated with exposure to elements, excessive

heat, hypothermia, impact of thebody upon the water, injection of water into my body orifices, encountering objects

either natural or manmade, exposure to animals with the attendant risk of kicking, biting, shying away, running off

or otherwise moving in an unanticipated manner causing injury and/or death.

4. My own negligence and/or the negligence of others, including but not limited to operator error and guide decision

making including misjudging terrain, rapids, weather, trails, or route location.

5. Attack by or encounter with insects, reptiles, and/or animals.

6. Accidents or illness occurring in remote places where there are no available medical facilities.

7. Fatigue, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.

*I understand the description of these risks is not complete and that unknown or unanticipated risks may result in

injury, illness, or death.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration for being permitted to participate in the activity (ies) described above and related activities, I

hereby agree, acknowledge and appreciate that:

1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY,

DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE,

the following named persons or entities, herein referred to as releasees.

VICTORY RIDE SKATEPARK - Owner (Company and/or Person)

2. To release the releasees, their officers, directors, employees, representatives, agents, and volunteers, and

vessels from liability and responsibility whatsoever and for any claims or causes of action that I, my estate,

heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising

from the above activities whether caused by active or passive negligence of the releasees or otherwise. By

executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any

injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the

above activities

3. By entering into this Agreement, I am not relying on any oral or written representation or statements made

by the releasees, other than what is set forth in this Agreement.

This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to

be unenforceable, the remaining terms shall be enforceable.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY

UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND

I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARTICIPANTS OF MINORITY AGE (19): THIS IS TO CERTIFY THAT I, AS PARENT, GUARDIAN, TEMPORARY

GUARDIAN WITH LEGAL RESPONSIBILITY FOR THIS PARTICIPANT, DO CONSENT AND AGREE NOT ONLY TO

HIS/HER RELEASE OF ALL RELEASEES, BUT ALSO TO RELEASE AND INDEMNIFY THE RELEASEES FROM

ANY AND ALL LIABILITIES INCIDENT TO HIS/HER INVOLVEMENT IN THESE PROGRAMS FOR MYSELF, MY HEIRS,

ASSIGNS, AND NEXT OF KIN.

I Agree
April 21, 2019

 RJ513 (03/2006)

 

PROTECTIVE HEADGEAR REFUSAL AGREEMENT

Please read and be certain you understand the implications of signing.

I, FOR MYSELF AND/OR ON BEHALF OF MY CHILD OR LEGAL WARD, HAVE BEEN FULLY WARNED

AND ADVISED BY VICTORY RIDE SKATEPARK THAT WE SHOULD WEAR A PROPERLY FITTED HELMET

IN ORDER TO REDUCE SOME OR ALL OF OUR HEAD INJURIES AS THE RESULT OF A FALL OR ANY

OTHER OCCURRENCE ASSOCIATED WITH THE HAZARDOUS ACTIVITY. WE REALIZE THAT WE ARE

SUBJECT TO INJURY FROM THIS ACTIVITY TO WHICH WE ARE EXPOSING OURSELVES PURELY

VOLUNTARILY. AGAINST THIS ADVICE, WE ARE REFUSING THIS CRITICAL SAFETY PRECAUTION.

I / WE THE UNDERSIGNED, HAVE READ THE FOREGOING STATEMENT AND DO UNDERSTAND ITS

WARNINGS AND ASSUMPTION OF RISKS.

FOR PARTICIPANTS OF MINORITY AGE (19): This is to certify that I, as Parent, Guardian, Temporary

Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of

all Releasees, but also to release and indemnify the Releasees from any and all liabilities incident to his/her

involvement in these programs for myself, my heirs, assigns, and next of kin.

I Agree
April 21, 2019

RJ541 (03/2006)

 

DECLARATION OF FITNESS

I hereby declare that I am physically fit. I do not, and have not, suffered from any of the following conditions,

which I understand may lead to a dangerous situation with regard to other persons or myself during these activities:

Epilepsy, fits, severe head injury, recurrent blackouts or giddiness, disease of the brain or nervous system,

high bloodpressure, lung or heart disease, recurrent weakness or dislocation of any limb, diabetes, mental

illness, drug or alcohol addiction, recent back injury, arthritis and severe joint sprains, chronic bronchitis,

asthma, rheumatic fever, thyroid adrenal or other glandular disorder, recent blood donation or any condition

that requires the regular use of drugs.

I hereby declare that I have no physical or mental condition that should preclude me from participating in my

chosen activity, that I am not participating against medical advice or treatment and that I have not been diagnosed

by a registered doctor as having a terminal illness.

I further declare that in the event that I feel ill or unwell, have any physical complaints whatsoever or if an injury

is sustained of any kind during the course of riding activities, I will notify the instructor I guide I employee of the

insured immediately anq before moving away from the immediate vicinity.

I HAVE READ THE ABOVE DECLARATIONS, UNDERSTAND THEM, AND I AGREE TO BE BOUND BY THEM.

*********************************************************************************************************

IF YOU CANNOT SIGN THE ABOVE DECLARATION BECAUSE OF ANY OF THE ABOVE CONDITIONS,

YOU MUST NOTIFY THE INSTRUCTOR / GUIDE / EMPLOYEE OF THE INSURED IMMEDIATELY BEFORE

YOU COMMENCE ANY ACTIVITIES.

*********************************************************************************************************

I Agree
April 21, 2019

(please print) Date RJ543 (03/2006)

 

PHOTOGRAPHY/VIDEO/AUDIO CONSENT AND RELEASE

I grant permission for my child OR myself to be photographed, videotaped, audiotaped or recorded by any other

means while participating in skating at The BAY or any event sponsored by The BAY. I consent to an waive any

privacy rights with regard to the display of such photographs or recordings and presentations, websites, television

programming and any other means.

I understand that Victory Ride Skatepark dba The BAY or Skate for Change owns the rights to such materials

and waive any rights with regard to such photographs or recordings or to broadcast, sale or display of such photographs.

I have read and understand this consent, below is my consent/non-consent.

I Agree
April 21, 2019

Please select who will be participating...
AdultMinor
Continue
First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
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*
ADDITIONAL MEDICAL NOTES

Please add any relevant medical information
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 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver