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PARITICPANT WAIVER

This form MUST be completed, signed and processed by Chiggy’s Skateboarding to enable you to use the ramps. If you are under 18, a parent or legal guardian MUST sign this form and their signature witnessed by another person over 18. You accept Chiggy’s Skateboarding Indoor Skate Park rules and regulations including the wearing of a helmet. Please complete your personal details and ensure the form is properly signed.

DECLARATION AND WAIVER RELEASE AND INDEMNITY DEED All persons must complete this document prior to participation. The activities described include adventurous recreational activities and are not without inherent risk. Chiggy’s Skateboarding thanks you for reading this document carefully. TO: Chiggy’s Skateboarding Indoor Skate Park, Queensland (including its directors, employees, principals, agents and independent contractors), (collectively referred to as “CSISP”): I confirm the following is true and correct and that CSISP has relied on my answers in allowing me to participate in recreational activities of and incidental to things including skateboarding, roller skating and scooter riding (“the activities”). In consideration of CSISP permitting me to participate in the activities, Name and Likeness Release I hereby grant permission to the event organisers, their successors and sponsors to use my name, image and likeness in direct connection with the activities for promotional broadcasting or reporting purposes in any and all manner and media, unless restricted by Privacy Legislation. Express Voluntary Assumption of Risk I understand that I, and each participant in the activities, will be engaging in activities involving a real risk of serious injury or even death from various causes including but not limited to equipment failure, accidents with other participants, spectators, course or weather conditions or other causes. I voluntarily accept all risks necessarily flowing from my participation, which could result in loss of life or injury. Liability Release and indemnity I hereby release CSISP and all persons or corporations associated directly or indirectly with the conduct of the activities from all claims, demands and proceedings arising out of my participation and hereby indemnify them against all liability (including liability for their negligence and the negligence of others) for all injury, loss or damage arising out of or connected with my participation in the activities. This release shall extend to and include CSISP and the promotion organiser, partners, managers, officers, agents, contractors, any club, organization and volunteers including medical and paramedical personnel appointed for the activities, the owners, licensees, and occupiers of land on which the activities or any part of it are conducted or which is involved directly or indirectly with the activities in any manner whatsoever and promoters, sponsors and activities organisers. This release and indemnity continues forever and binds my heirs, executors, personal representative and assigns. Equipment and Facilities Inspection I agree that before I participate in the activities, I will independently inspect the related facilities and equipment. I will immediately advise CSISP of any unsafe condition that I have observed. I will refuse to participate in the activities until all unsafe conditions observed by me have been remedied. I acknowledge that reasonable safety precautions are undertaken by CSISP and the ramp builder (such as supervision, helmet safety checks), but such are a service to me and other participants and are not a surety of safety. Protective Equipment As an activities participant I hereby agree to supply and wear my own suitable helmet, skate shoes or runners plus a tee shirt and shorts as the minimum protective equipment requirements at all times whilst I am taking part in the activities. Physical Fitness I have independently assessed the activities and I am physically fit to participate in the activities in which I have chosen to participate and have not been advised otherwise by a medical practitioner. I do not have any possibly relevant pre-existing medical or physical conditions, which have not been disclosed to CSISP and the activities organisers. Medical Treatment I consent to receiving any medical, eg first aid, treatment that CSISP considers reasonably necessary during or after the activities. Personal Property I hereby acknowledge that I have the sole responsibility for my personal property during the activities. I acknowledge the terms and conditions of this document are contractual in nature, are intended to have legal effect and are not a mere warning or recital. CSISP is not responsible for my decision to participate in the activities and I was not induced by CSISP to do so. I acknowledge my registration is not transferable to any other person. I have read this document, understand its contents and complete it of my own free will.

Today's Date: December 2, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
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*
If the person executing the foregoing is a legal infant or minor (under 18 years of age), the following section must be completed: I am a parent or legal guardian of the legal infant or minor who is named above. I hereby covenant and warrant my answers provided are true and correct and hereby agree that we shall both be bound by this document.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Check your preferred sport/s
Skateboarding
Scooter
Roller skating
Have you ridden ramps before?*
No
Yes
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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