IF YOU ARE UNDER 18, YOUR PARENT OR LEGAL GUARDIAN MUST SIGN
THIS WAIVER.
In consideration of
being allowed to participate in any way in the Skate Park of Lake
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 or others, and assume full responsibility for
my participation; and,
3.
I willingly
agree to comply with the stated and customary 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 official immediately; and,
4.
I, for myself
and on behalf of my/ our heirs, assigns, personal representatives and next of
kin, HEREBY RELEASE Action Park Alliance, Inc., Spohn
Ranch, Inc., Alliance of Lake Elsinore, The City of
Lake Elsinore, and its officers, officials, agents,
and/ or employees, other participants, sanctioned events, sanctioned parks,
sanctioned organizations, sponsoring agencies, sponsors, advertisers, and if
applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY,
DISABILITY, DEATH, or loss or damage to person or property incident to my
involvement or participation in these programs, WHETHER ARISING FROM THE
NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by
law.
5.
I, for myself
and on behalf of my/ our heirs, assigns, personal representatives and next of
kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees
from any and all liabilities incident to my involvement or participation in
these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent of
the law.
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!
PARTICIPANT SIGNATURE DATE SIGNED DATE OF BIRTH
Name: Form
of ID:
Address: Apt.
#: E-Mail:
City: State: Zip: Phone:
IF
PARTICIPANT IS UNDER 18 YEARS OF AGE Emergency Phone:
PARENT/ LEGAL GUARDIAN SIGNATURE DATE SIGNED DRIVER LICENSE #
PRINT PARENT/ LEGAL GUARDIAN NAME
MEDICAL RELEASE: In
the event that I cannot be reached in an emergency, I hereby give permission to
any licensed physician, surgeon, clinic, or hospital to secure proper
treatment, and to order anesthesia, for my child/ myself as named above. My child/ I am
allergic to the following medications:
DOCTOR to be notified in case of emergency:
Legal Guardian/ Parent or +18 year participant signature
WITNESS SIGNATURE DATE
SIGNED
TITLE AND ORGANIZATION, EVENT OR PARK:
SIGNATURE MUST BE NOTARIZED
UNLESS WITNESSED BY A PRINCIPAL OF THE