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RELEASE OF LIABILITY AND WAIVER OF ALL CLAIMS Participant and/or Participant's parent(s) or guardian acknowledge that ice skating is inherently dangerous activities that involve risk of accident, property damage, serious bodily injury and death. By signing this Release, Participant, and/or Participant's parents(s) or guardian, assume full responsibility for any risk of injury, property damage, or death arising out of Participant's use of the Kernersville Museum Ice Skating Rink (hereafter both referred to as the "Rink"). Participant agrees that Kernersville Museum Foundation and the Town of Kernersville, including without limitation, all affiliates, divisions, Kernersville Museum Foundation officers, attorneys, employees, agents, assigns, representatives, or successors (collectively "Kernersville Museum and The Town of Kernersville"), are not responsible for any injury or damages of Participant arising out of, or related to, Participant's use of the Rink. Participant and/or Participant's parent(s) or guardian (collectively "Releasing Parties") hereby waive, release, and forever discharge any and all claims for damages, loss, personal injury, or death that Releasing Parties may encounter related to or arising out of Releasing Parties' activities at the Rink.

This Release is intended to fully and completely discharge Kernersville Museum and all sponsors of the Kernersville Museum Ice Skating Rink and their subsidiaries, affiliates, partners, officers, directors, employees, agents, and volunteers from any and all liability for any loss, damage, or expense that Releasing Parties or Releasing Parties' respective heirs, assigns and legal representatives may suffer as a result of Releasing Parties' use of the Rink and surrounding areas, from any cause whatsoever, including without limitation, any act, omission, error, negligence or breach of contract on the part of Kernersville Museum or any sponsors of the Rink, in the operation, supervision, design, maintenance, or condition of the Rink and all surrounding areas.

This release is intended to be as broad and inclusive as permitted by law, and is intended to be effective and binding upon Releasing Parties' heirs, next of kin, families, relatives, guardians, conservators, executors, administrators, trustees and assigns. Participant certifies that: (a) Participant has been advised to consult a physician before using the Rink; (b) Participant is in good physical health sufficient to use the Rink; (c) Participant is not under the influence of alcohol or any illegal drugs; and (d) Participant is not taking any medication that would prevent Participant from safely using the Rink. Participant and/or Participant's parent(s) or guardian(s) agree to follow all rules posted at the Rink and surrounding areas, and instructions from the operating staff of the Rink. Participant further agrees to abide by the "Code of Skater Conduct" as posted within the Rink area. Failure to follow the "Code of Skater Conduct" rules posted at the Rink and surrounding areas, or instructions from the operating staff of the Rink may result in the termination of Participant's use of the Rink, surrounding areas, and rental skates without refund. Releasing Parties agree to, at Releasing Parties' sole expense, and with legal counsel reasonably acceptable to Kernersville Museum, defend, indemnify and hold harmless Kernersville Museum from and against any and all accidents, injuries, liability, claims, costs or expenses related to any act, error, omission, or negligence of Releasing Parities, arising out of, or related to, Releasing Parties' use of the Rink and surrounding areas. Releasing Parties hereby authorize Kernersville Museum to use any photographs, videotapes, recordings or any other records taken of Releasing Parties while at the Rink and surrounding areas for publicity, advertising, or any other legitimate purpose.

BY SIGNING THIS RELEASE, I UNDERSTAND THAT I AM RELEASING KERNERSVILLE MUSEUM, the Town of Kernersville AND ALL SPONSORS OF THE RINK FROM ANY POTENTIAL CLAIMS FOR DAMAGES CAUSED BY ANY ACT, ERROR, OMISSION OR NEGLIGENCE OF KERNERSVILLE MUSEUM OR OTHER SPONSORS.

Today's Date: January 19, 2021

First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
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*
This is to certify that I, as parent or guardian with legal responsibility for the Participant, do consent and agree to his/her release as provided above. I further agree that I will not leave the Rink area and will remain in a location close enough to supervise and remain responsible for the Participant’s safety and welfare. To the fullest extent permitted by law, I hereby release and agree to indemnify Kernersville Museum and the Town of Kernersville and all sponsors of the Rink and their subsidiaries, affiliates, partners, officers, directors, employees, agents, and volunteers from any and all liabilities incident to the Participant's involvement or participation in the ice or roller skating activities offered at the Rink and surrounding areas, even if arising from any act, error, omission or negligence of Kernersville Museum and/ or the Town of Kernersville and/or a sponsor of the Rink.
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.


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