SKATEPARK WAIVER & RELEASE FORM
In consideration for being allowed to participate in any way at Alliance Skatepark of Grand Prairie, its related events, and
activities, the undersigned acknowledges, appreciates, and agrees that:
1.
The risk of
injury from the activities involved in these programs is significant, including
the potential for permanent disability and death, and while particular rules,
equipment, and personal discipline may reduce this risk, the risk of serious
injury to me does exist; and,
2.
I KNOWINGLY AND
FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE
NEGLIGENCE OF THE RELEASEES (as defined in paragraph 4 below) or others, and
assume full responsibility for my participation; and,
3.
I willingly
agree to comply with the stated and customary rules, terms and conditions for
participation. If I observe any
unusual significant concern in my readiness for participation and/ or in the
program itself, I will remove myself from participation and bring such to the
attention of the nearest Alliance Skatepark of Grand
Prairie official immediately; and,
4.
I, FOR MYSELF
AND ON BEHALF OF MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND NEXT OF KIN,
HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS ACTION PARK ALLIANCE, INC., SPOHN
RANCH, INC, THE CITY OF GRAND PRAIRIE, TEXAS AND THEIR OFFICERS, ELECTED
OFFICIALS, AGENTS, EMPLOYEES, OTHER PARTICIPANTS, SANCTIONED EVENTS, SANCTIONED
ORGANIZATIONS, SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND IF APPLICABLE,
OWNERS AND LESSORS OF ALLIANCE SKATEPARK OF GRAND PRAIRIE (“RELEASES”) FROM ANY
AND ALL CLAIMS ARISING OUT OF MY PRESENCE AT ALLIANCE SKATEPARK OF GRAND
PRAIRIE, INCLUDING, BUT NOT LIMITED TO, CLAIMS FOR ANY AND ALL INJURIES,
DISABILITY, DEATH,OR LOSS OR DAMAGE
TO PERSON OR PROPERTY,WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR
OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW, INCLUDING ATTORNEY’S FEES AND
ATTORNEY’S FEES ON APPEAL.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I attest that I
am physically fit and have been trained for this activity. I also waive and release the use of my
photograph or likeness for any reason or purpose. I WANT TO PARTICIPATE IN THIS
HAZARDOUS SPORT!
MEDICAL RELEASE: In the event
that I am unconscious or otherwise unable to make medical decisions for myself
in an emergency, I hereby give permission for medical treatment, and related
transportation, to any licensed physician, surgeon, clinic, hospital or
ambulance service to secure proper treatment, and to order anesthesia, for
myself as named above. I am allergic to the following
medications:
.
SIGNATURES MUST BE NOTARIZED UNLESS WITNESSED BY A PRINCIPAL OF THE ACTION PARK
ALLIANCE, INC.
PARTICIPANT SIGNATURE
Date Signed
Date of Birth
Name:
Form of ID:
Address:
Apt. #:
E-Mail:
City:
State:
Zip:
Phone:
DOCTOR to be notified
in case of emergency:
Action Park Alliance
WITNESS SIGNATURE Date Signed
Title and
organization, event or park:
OR
COUNTY OF ___________
SWORN TO AND SUBSCRIBED before me this _____ day of __________, 2006, by
___________________, who is personally known to me or has produced a
_______________ as identification.
__________________________
Notary Public
My Commission Expires: ______