Dissent Skate Ramp Waiver Form

DISSENT SKATE SHOP MINI-RAMP LIABILITY WAIVER AND REGISTRATION FORM

WARNING: IN-LINE SKATING, SKATEBOARDING, SCOOTERING AND BMX BICYCLING ARE

DANGEROUS ACTIVITIES. BY ENGAGING IN THESE ACTIVITIES, THE PARTICIPANT ASSUMES THE RISK OF SERIOUS INJURY OR DEATH. 

THIS IS A RELEASE OF LIABILITY—YOU MUST READ AND FULLY UNDERSTAND THIS BEFORE SIGNING. IF YOU ARE UNDER 16, YOUR PARENT OR LEGAL GUARDIAN MUST SIGN THIS WAIVER.

Participation Statement:

“Skatepark activities have a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement. Additionally, appropriate safety protection is strongly advised be worn at all times such as Helmet, Elbow Pads, Wrist Guards, Gloves and Knee Pads”.

Participant Name: ______________________________________________________________

Address:______________________________________________________________________

City _______________________ County __________________ Post Code ______________

Phone: ________________________ E-Mail Address: ____ ___________________________

Emergency Contact: _________________________

Full Name of Parent/Legal Guardian: _________________________

Main Phone No. _________________________

UNDER 16s

Conditions of Registration:

I have read the above participation statement and consent to my child using the Skate Ramp at Dissent. I have ensured that my child understands that the Terms and Conditions and any instructions given by staff must be adhered to at all times. I undertake to inform Dissent of any changes in my child’s health, and any medical treatment received.

DECLARATION OF FACT

I confirm that the above information is correct and if any information changes I will notify the centre.

Parent/Legal Guardian’s signature: __________________________ Date:______________

I wish to use the skate ramp located in the premises of Dissent Skate Shop, Manor Road, Scarborough.

I verify that I have full knowledge of the rigours and risk involved in using the Skate Ramp and I understand that skating can be a dangerous sport. I am voluntarily using the Skate Ramp with knowledge of the dangers involved, including without limitation, the risks of disability, injury, loss, damages, or the negligence or deliberate act of another person and I agree to accept any and all aforementioned risks.

I understand that by entering into the premises of the Skate Ramp, I will be using facilities and/or areas where many hazards exist, and I am aware of and appreciate the risks which may result from my use of those facilities.

I understand that skateboarding under the influence of alcohol at this premisses is prohibited.

I am aware that accidents or illness can occur during skating and that I may be seriously injured as a result.

I acknowledge that I am solely responsible for my personal health and safety, and the personal property I bring with me.

I agree to respect the Skate Ramp rules, to respect other riders, to follow the organisation’s

recommendations for my safety while skating. I understand that not respecting these rules could cause in my exclusion from the Skate Ramp, through a decision of Dissent.

In consideration for being permitted to skating on the Skate Ramp, I agree to assume all risks and to release in advance and hold harmless and discharge Dissent, the operator, all affiliated organisations, individuals and entities, first-aid volunteers, officials, participating communities, organisations, and all of their respective parents, subsidiaries, officers, directors, agents, employees and members from any liability and to waive my rights with respect to any and all claims for damages personal injury or property damage which I may have, or which may hereafter accrue to me as a result of my usage of the Skate Ramp, even though this liability may arise through no fault of my own, or from the negligence or carelessness on the part of the

persons or entities being released, from dangerous or defective property or equipment owned, maintained or controlled by them or because of their possible liability without fault.

I understand that my name, photograph, voice or likeness may be used by Dissent for promotional and advertising purposes, directly and through third parties, including the featuring of all of the foregoing in promotional materials and the assignment of all the exploitation rights to third parties, partners of Dissent, and this without any right to compensation and without time limitation. In particular, the rights hereby assigned to Dissent will include all the utilisation and exploitation rights worldwide and have to be considered unlimited with reference to duration, content, territory and transmission device. I consent to and authorise, in advance, such use and waive any rights of privacy and/or publicity I may have in connection therewith.

I understand that, by entering and using the Skate Ramp, I consent that the personal information I submit with my entry being entered into a database and Dissent together with the operator may use this information for the purposes of the Skate Facility.

In addition, with my specific consent which is optional, Dissent may also collect my personal data for statistical purposes as well as for marketing purposes, notably to send me periodic communications containing information on Dissent’s products and/or services, as well as on its promotional or marketing initiatives, including possible invitations to said initiatives, it being understood that I can always oppose receiving marketing communications: every communication will contain a special section indicating the methods for withdrawing my consent.

I understand that all my personal details will be stored at the office of Dissent. A request to access,

update, correct or deletion any information should be directed to the hereinafter provided address of the operative offices of Dissent.

Personal data are processed by Dissent and the operator in compliance with the security

provisions as set forth by applicable laws and regulations in order to prevent loss of data, unlawful or unfair use of data and unauthorised access to data.

I HAVE CAREFULLY READ THIS WAIVER AND RELEASE OF LIABILITY AND FULLY UNDERSTAND ITS CONTENTS.

Since I am under 16 years of age at the time of registration, my parent or legal guardian has completely reviewed this form, understands and consents to its terms, and authorises my participation by his/her signature below.

Signature: ________________________________

Signature (Parent or Legal Guardian signature for approval): __________________________