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Roller Pump Fitness LLC.,

South Side Roller Derby Inc.,

Pearwood Skate LLC.

WAIVER & ACKNOWLEDGEMENT




Beginner Class Skaters

Equipment and Skates: Participants must wear the following mandatory safety equipment during all beginner classes.

  • Knee, Elbow and Wrist Pads, Helmet, and Quad Roller Skates.
  • All skates and protective gear must be surface safe, meaning that their use must not gash, indent or blemish the skating surface or any other surface and that the skates will not cause injury to property or person(s). All liabilities thereof are assumed by the undersigned.

Roller Derby Skaters

Equipment and Skates: Participants must wear the following mandatory safety equipment during all South Side Roller Derby Roller Derby on-skate activities and practices:

  • Knee, Elbow and Wrist Pads, Helmet, Mouthguard and Quad Roller Skates.
  • All skates and protective gear must be surface safe, meaning that their use must not gash, indent or blemish the skating surface or any other surface and that the skates will not cause injury to property or person(s). All liabilities thereof are assumed by the undersigned.

Roller Dance Skaters

  • Protective gear is highly recommended but not required. If you are at risk of falling or trying new moves, jumps, spins, and footwork, we highly suggest gear up until you are comfortable with awesome moves.

Outdoor Skaters

  • Protective gear is highly recommended but not required. If you are at risk of falling or trying new moves, jumps, spins, and footwork, we highly suggest gear up until you are comfortable with awesome moves.

Conduct: Participants & Spectators (patrons on the premises as a result of your involvement in the skating practice, public appearances, fundraising activities or any other sanctioned South Side Roller Derby activity) must behave in a respectful manner to both person and property. Behavior which could potentially lead to intentional or unintentional bodily injury or damage to property will not be tolerated.

Indemnification and Risk Acknowledgment: In of being allowed to participate in any way in the South Side Roller Derby roller skating programs and classes, related events, and activities, including, but not limited to: practice sessions, team meetings, public appearances, fundraising activities or travel to and from the aforementioned activities, the undersigned acknowledges, appreciates and agrees that:

1. The risk of injuries from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury remains.

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and I assume full responsibility for my participation.

3. I willingly agree to comply with the stated and customary terms and conditions

for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such hazard to the attention of the nearest official, trainer, or coach, immediately.

I hereby agree to release, indemnify, and discharge Roller Pump Fitness LLC., South Side Roller Derby Inc., Roller Enterprises of Texas Inc., Funcity, Castro Entertainment LLC, on behalf of myself, my children, my parents, my heirs, assigns, personal representative, and estate as follows:

  • I acknowledge that my participation in roller sports, or other activities or sports known as dangerous but not mentioned above entails known and unanticipated risk that could result in physical or emotional injury, paralysis, death, or damage to myself to property, or to third parties, I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
  • THE RISK INCLUDE, AMONG OTHER THINGS: Collision with other participants, the walls, or other fixed objects; falling down; my own equipment failure or the failure of others' equipment; my own or others' negligence; and objects or conditions on the surface that may cause me to fall; broken bones, sprains, head and back injuries, abrasions, bruises, loss or impairment of vision, damage to teeth, damage to internal organs, loss of limb, paralysis and death. Furthermore, Roller Pump Fitness LLC., South Side Roller Derby Inc., Roller Enterprises of Texas Inc., Funcity, Castro Entertainment LLC staff have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They may give inadequate warnings or instructions, and the equipment being used might malfunction.
  • I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risk.
  • I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless South Side Roller Derby from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Roller Pump Fitness LLC., South Side Roller Derby Inc., Roller Enterprises of Texas Inc., Funcity, Castro Entertainment LLC's equipment or facilities, including any such claims which allege negligent acts or omissions of Roller Pump Fitness LLC., South Side Roller Derby Inc., Roller Enterprises of Texas Inc., Funcity, Castro Entertainment LLC.
  • Should Roller Pump Fitness LLC., South Side Roller Derby Inc., Roller Enterprises of Texas Inc., Funcity, Castro Entertainment LLC, or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
  • I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS any Roller Pump Fitness LLC., South Side Roller Derby Inc., Roller Enterprises of Texas Inc., Funcity, Castro Entertainment LLC's rinks, outdoor skating surface owners, coaches, their officers, officials, agents, and/or employees, other participants, volunteers, sponsoring agencies, sponsors and advertisers (“RELEASES”) WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss, or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE.

I HAVE READ THIS ASSUMPTION OF RISK AGREEMENT, ACKNOWLEDGMENT AND I ACCEPT RESPONSIBILITY; I FULLY UNDERSTAND ITS TERMS, AND I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

May 20, 2024








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*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
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*

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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