SKATELIFE SKATE PARK

(Please Print)

NAME: _____________________________________ DATE OF BIRTH: ___________________________

STREET ADDRESS: ______________________________________________________________________

CITY: _______________________________ STATE: _______________________ ZIP CODE: _________

HOME PHONE: _(______)_________________ CELL PHONE: _(______)___________________

WORK PHONE: _(______)___________________

EMERGENCY CONTACTS AND PHONE: _________________________________________________

_____________________________________________________________________________________

SKATEBOARD _____ INLINE _____ BIKE _____

AMATUER ATHLETIC WAIVER AND RELEASE OF LIABILITY

PLEASE READ BEFORE SIGNING

IN CONSIDERATION OF BEING ALLOWED TO PARTICIPATE IN ANY WAY IN THE SKATELIFE SKATE PARK ATHLETIC/SPORTS PROGRAM, RELATED EVENTS, AND ACTIVITIES, I _____________________________ (NAME OF PARTICIPANT) THE UNDERSIGNED ACHKNOWLEDGE, APPRECIATE, AND AGREE THAT:

1.) The risk of injury from the activities involved in this program is significant, including the potential to permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist: and,

2.) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both know and unknown. EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility to my participation: and,

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, will remove myself from participation and bring such to the attention of the nearest official immediately: and,

4.) I, for myself and behalf of my heirs, assigns, personal, and representatives, and next of kin, HEREBY RELEASE AND HOLD HARMLESS, SKATELIFE SKATE PARK, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable owners and lessors of premises used to conduct the event ("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 RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT.

X____________________________________ AGE: ____________

DATE SIGNED: ______________________________

FOR PARTICIPANTS OF MINORITY AGE

(UNDER AGE 18 AT THE TIME OF REGISTRATION)

This is to certify that I as a parent/legal guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all Releases, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnity the Releasees from any and all habilities indicident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by GEORGIA law.

X _____________________________________ DATE: _____________

EMERGENCE PHONE: (_____)___________________