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Waiver of Liability for Roller Skating

WAIVER, RELEASE, HOLD HARMLESS, AND INDEMNIFICATION AGREEMENT

                        

As consideration for being allowed to participate in rental of roller skates and/or participation in Aloha Roller Rink, the undersigned acknowledges, appreciates, understands and agrees to the following:                    

I, on behalf of myself and, if applicable, my child or ward, acknowledge and understand that there are known and unknown risks associated with participation in the activity, which include but are not limited to: injuries, contusions, fractures, scrapes, cuts, bumps, paralysis, or death.

I, on behalf of myself and, if applicable, my child or ward, willingly assume the risks associated with participation and accept that there are also risks that may arise due to OTHER PARTICIPANTS which I also willingly assume.

I agree I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation.

I (on behalf of myself, my child or ward, my spouse, heirs, assigns, representatives and next of kin) agree to hold harmless, release, waive, and indemnify the independent owner of the property, Aloha Roller Rink, Eastridge Center, Elizabeth Ruiz, San Jose Parks & Recreation, San Jose Police Department,  the City of San Jose, the County of Santa Clara, and any other associated entities, their predecessors, successors, agents, parent, subsidiaries and affiliates, members, officers, independent contractors, employees and volunteers from any and all claims, causes of action, injuries, liabilities, or damages from participation, including any claim that may arise due to negligence or gross negligence on their part.

I (on behalf of myself, my child or ward, my spouse, heirs, assigns, representatives and next of kin) additionally agree to indemnify the independent owner of the property, Aloha Roller Rink, Roosevelt Park, Elizabeth Ruiz, San Jose Parks & Recreation, San Jose Police Department, the City of San Jose, the County of Santa Clara, and any other associated entities, their predecessors, successors, agents, parent, subsidiaries and affiliates, members, officers, independent contractors, employees and volunteers for any defense cost or expense arising from any and all claims, causes of action, injuries, liabilities, or damages arising from participation, including any claim that may arise due to negligence or gross negligence on their part.

I am physically able to participate and am legally competent to understand and complete this agreement. I hereby execute this agreement without coercion. I have read and understand the rules and agree to comply to them.

I understand that participation by myself and, if applicable, my child or ward, constitutes consent to use any film, video, or likeness of participants for any purposes whatsoever, without payment to the participant.

The invalidity or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision of this Agreement, which shall remain in full force and effect.        

9.     Any controversy, dispute, or claim arising out of or relation to this Agreement, which the parties are unable to resolve by mutual agreement, shall be settled exclusively by submission by either party of the controversy, claim or dispute to binding arbitration in Santa Clara County before a single arbitrator in accordance with the rules of the American Arbitration Association then in effect.

                    

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Date

Date *
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*

Middle 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.


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