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DISRUPT SKATESHOP
SKATEBOARDING LESSONS WAIVER & RELEASE OF LIABILITY

_Disrupting limits. Elevating skill. Riding with purpose._

**Acknowledgment of Risk**

I understand that skateboarding is an inherently risky activity, with the potential for serious injury or death. These risks include, but are not limited to, falls, collisions, obstacles, terrain changes, and weather conditions — all of which may occur during Disrupt Skateshop lessons at Sunshine Skatepark, the Disrupt store training area, or offsite events.

**Assumption of Risk**

I choose to participate fully aware of these risks and accept full personal responsibility for my actions and well-being.

**Release of Liability**

In exchange for being allowed to participate in lessons with Disrupt Skateshop, I agree to release and discharge Disrupt Skateshop, its owners, instructors, volunteers, sponsors, and affiliates from any claims or liability for personal injury, property damage, or wrongful death. This release applies to all known and unknown risks, regardless of cause.

**Medical Authorization**

In the event of injury or emergency, I authorize Disrupt Skateshop instructors or staff to administer first aid and seek emergency medical treatment if needed. I understand that any related medical expenses are my sole responsibility.

**Code of Conduct**

I agree to follow all safety instructions, wear proper safety gear (helmet mandatory), and treat others with respect. Disrupt Skateshop reserves the right to remove anyone from lessons who poses a danger to themselves or others or fails to follow safety guidelines.

**Parental Consent (If under 18)**

As parent/legal guardian, I have read this waiver and agree to its terms on behalf of my child. I consent to their participation in Disrupt Skateshop lessons and assume all associated risks.

Date: May 8, 2025

https://disruptskateshop.com/

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Third Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Fourth Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Fifth Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Sixth Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Seventh Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Eighth Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Ninth Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Tenth Participant's Name

First Name*

Middle Name

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

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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 Information

**Media & Photo Consent**

Disrupt Skateshop often captures rad moments to celebrate our riders and share inspiration with the community.*
I consent to the use of photos/videos of me (or my child) taken during lessons or events, and grant permission for Disrupt Skateshop to use them for promotional, social media, and marketing purposes.
Check here if you do NOT consent to media usage.
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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