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716-837-8743

4430 Bailey Ave. Buffalo NY 14226

 

VOLUNTARY RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

PLEASE HAVE YOUR DRIVERS LICENSE / IDENTIFICATION AVAILABLE TO REVIEW

I, the named person being 18 years or older in age, or the legal guardian of the below named person who is under the age of 18 in consideration of the services provided by PHATMAN BOARDSHOP its corporate identities (Knab Enterprises Inc. DBA PHATMAN), it’s agents, representatives and employees, the promoters, other participants, officials, advertisers, sponsors and owners or leasers of the premise used to conduct the services hereinafter collectively referred to as “PHATMAN BOARDSHOP”), hereby acknowledge, agree, promise and covenant on the behalf of myself, my heirs, assigns representatives and estate as follows.

 

I. APPLICABILITY OF THIS AGREEMENT I UNDERSTAND AND ACKNOWLEDGE that this Voluntary Release of Liability and Assumption of Risk Agreement (hereinafter “Agreement”) shall apply to my participation in any and all services, activities and programs provided by PHATMAN BOARDSHOP and the owners of the property being used, including, but not limited to, open skating, skating, skateboarding, snowboarding, biking riding, practice sessions, instructional sessions and competitions directed by PHATMAN BOARDSHOP. For the purposes of this agreement, the term “Activity” shall include, but not be limited to, in-line skating, skateboarding, snowboarding, BMX freestyle biking and the observation of these activities. I UNDERSTAND AND ACKNOWLEDGE that this agreement shall apply to all of my future visits to PHATMAN BOARDSHOP locations and to property owned by the leasers which the activities are being performed.

II. ACKNOWLEDGMENT OF RISK I understand and acknowledge that the activity that I am about to voluntarily engage in as a participant or spectator bears certain known and unknown risks which could result in INJURY, DISABILITY, DEATH, ILLNESS OR DISEASE, PHYSICAL OR MENTAL DAMAGE, OR LOSS to myself, to my property, or to spectators or other third parties. I understand and acknowledge those risks may result in personal claims against PHATMAN BOARDSHOP or the owners of the property being used, or claims against me by spectators or other third parties. These risks include but are in no way limited to the following:

1. Falling, and or coming in contact with ramps, steps, curbs, walls, sidewalks, stones, gravel, or other    equipment obstacles in the vicinity of the ramps, that was built or is naturally occurring:

2. Latent or appararent defects or conditions in equipment or property supplied by PHATMAN BOARDSHOP or by the owners of the property being used, or other persons entities:

3. The conditions of any track, ramp or other equipment and accidents connected to their use:

4. My own physical condition or my own act or omissions:

5. The physical condition, acts or omissions of other permissions:

6. First aid, emergency treatment or other services rendered by PHATMAN BOARDSHOP or the owners of the property being used, or others, and the consumption of any food or drink, whether or not provided by PHATMAN BOARDSHOP:

 

I UNDERSTAND AND ACKNOWLEDGE that the above list is not complete or exhaustive and that other risks, known or unknown, identified or unidentified, anticipated or unanticipated, may also result in injury, loss, disability, death, illness, disease, or damage to myself, or my property, or two spectators or other third parties.

III. RELEASE I VOLUNTARILY RELEASE, HOLD HARMLESS AND FOREVER DISCHARGE PHATMAN BOARDSHOP AND THE OWNERS LEASERS OF THE PROPERTY BEING USED, and all the persons or entities affiliated there with, from any and all liability, claims, demands, actions or rights of action, which are related to, arise from or are in any way connected with my participation in the activity, including, but not specifically limited to any and all negligence fault or liability of PHATMAN BOARDSHOP or the owners / leasers of the property being used and all other persons or entities, for any and all injury, disability, death, illness or disease, loss and damage to myself or to my property. I FURTHER AGREE, PROMISE AND COVENANT not to use, assert or otherwise maintain any claim against PHATMAN BOARDSHOP or the owners / leasers of the property being used, and all the other persons or entities, for injury, death, disability, illness or disease, loss or damage to myself or my property, arising from or connected with my participation in this activity or from any claims asserted against me by spectators or other third parties. IN SIGNING THIS DOCUMENT, I FULLY RECOGNIZE THAT I WILL RELEASE AND HOLD HARMLESS PHATMAN BOARDSHOP AND THE OWNERS LEASERS OF THE PROPERTY BEING USED WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH OR LOSS OR DAMAGE TO PERSONAL PROPERTY, WHETHER RESULTING FROM THE NEGLIGENCE OF PHATMAN BOARDSHOP OR THE OWNERS LEASERS OF THE PROPERTY BEING USED OR OTHERWISE.

IV. PARTICIPANT INSURANCE BENEFITS AND REPRESENTATION OF PHYSICAL CONDITIONS I understand and acknowledge that no major medical insurance benefits will be provided to me by PHATMAN BOARDSHOP or by the owners of the property being used during this activity. I certify that I have sufficient health accident and personal liability insurance to cover bodily injury or property damage caused to a third-party as a result of my participation in this activity. If I have no such insurance, I certified that I am capable of personally paying for any and all such expenses or liability. I FURTHER ACKNOWLEDGE that I am in good physical and mental health and not suffering from any condition, disease or disability which would or could potentially affect my participation in the activity.

V. SEVERABILITY if any portion of this agreement is held and valid, it is agreed that the balance shall continue in full force and effect.

 

This is to certify that I as parent / guardian with the legal responsibility for this participant to consent and agreed to his her release provided above of PHATMAN BOARDSHOP as such term is defined above, and agree to identify and hold harmless PHATMAN BOARDSHOP and the owners leasers of the property being used from any and all liability incident to my minor child’s involvement or participation in the activity, as such as defined above, even if arising from the negligence of PHATMAN BOARDSHOP or the owners leasers of the property being used.

 

I HAVE READ THIS ENTIRE AGREEMENT, I FULLY UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

 

 


First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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(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 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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