Loading...

LIABILITY WAIVER AND HOLD HARMLESS AGREEMENT

As a participant and in consideration of the Participant being permitted to participate in any activity, program or party provided by SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE, I the Participant agree as follows:

1. Assumption of Risk – I acknowledge that by participating in the programs and activities provided by SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE, such activities include but are not limited to public roller skating and inline skating events and parties with rental skates or member’s own skates, learn to skate classes, and coaching including roller dance classes, skate park activities, and/or any other services offered by SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE, and/or by using the facilities used for such events and activities creates risk of severe bodily injury to the Participant. Injuries that could result will vary, but may include (a) minor injuries such as scratches, bruises and sprains; (b) major injuries such as eye injuries, joint or back injuries, broken bones and concussions; (c) catastrophic injuries including paralysis and even death. Notwithstanding these risks and other hazards that may be foreseeable but not specifically identified herein, I, and my respective heirs, personal representatives and assigns understand, acknowledge, and expressly and voluntarily assume all risks and full responsibility for any injury arising out of or related to the programs and activities provided by SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE. Such risks and hazards include but are not limited to: falls, tripping, collisions with other participants or an object at the facility, malfunction of equipment or equipment failure, etc.

2. Release, Discharge and Agreement Not to Sue – I, and my respective heirs, personal representatives and assigns, do hereby release, discharge and agree not to sue SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE, and the facility used for such events and activities, and its managers, members, employees, and/or other agents, for any injury to or death of myself, and my respective heirs, personal representatives and assigns, arising, directly or indirectly, from participation in any and all activities, programs, and/or parties provided by SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE. This release, discharge and covenant not to sue shall relate to any and all claims or legal rights now existing or arising in the future, including claims and legal rights arising out of any negligence of SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE and/or the facility used for such events and activities and/or its managers, members, employees and/or other agents and any other breach of a legal duty arising out of common law, statute, contract or otherwise.

3. Indemnification and Hold Harmless – I agree to indemnify SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE, and the facility used for such events and activities and hold harmless from, without limitation, any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including solicitor’s fee and costs incurred due to claims brought by any third party as a result of or arising out of the Participant’s involvement in any and all activities, programs, and/or parties provided by SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE, and the facility used for such activities and events and to reimburse SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE, and the facility used for such activities and events for any such costs, expenses and fees as they are incurred.

4. I have read and I understand all of the provisions of this document and the risks identified in paragraph 1 herein. I understand that the activities could cause injury and even death. I acknowledge that I have read and understand the terms of this document and I am freely and voluntarily signing this document.

5. I understand that my agreement and completion of this Waiver for the first activity or program will authorize SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE to use it as a continuous waiver for my ongoing participation. I hereby expressly authorize SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, and PENTICTON ROLLER SKATE to use this waiver until I have expressed to change this in writing.

6. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

7. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, and organizers.

COVID-19 ACKLOWLEDGEMENT

  • I certify that I have not been or felt sick in at least 14 days prior to attending PENTICTON ROLLER SKATE events.
  • I have not called in sick to work in the previous 14 days prior to attending PENTICTON ROLLER SKATE events.
  • I have not been in the presence of anyone who has tested positive for COVID-19 7 days prior to attending PENTICTON ROLLER SKATE events.

I HAVE READ THE ABOVE WAIVER AND BY SIGNING IT I AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE SOUTH OKANAGAN ROLLER DERBY ASSOCIATION, AND PENTICTON ROLLER SKATE FROM ALL LIABILITY ARISING FROM THE ACTIVITIES, PROGRAMS, OR PARTIES PROVIDED BY SOUTH OKANAGAN ROLLER DERBY ASSOCIATION AND PENTICTON ROLLER SKATE.

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*
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*

Relationship*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!