Adult Parent/Guardian Name *

First Name

Last Name

Adult Parent/Guardian Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

First Minor's Name *

First Name

Last Name

First Minor's Date of Birth *

MM

DD

YYYY

Second Minor's Name *

First Name

Last Name

Second Minor's Date of Birth *

MM

DD

YYYY

By typing your name in the final text box, you, as the parent/guardian, and all the skaters listed in this form agree to the following terms: I, the parent/guardian of the minor participants and/or the adult participant, hereby assume all of the risks of participating in any and all activities associated with Interskate Roller Rink. This includes, but is not limited to, any risks that may arise from negligence or property carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, and/or controlled by them, or because of their possible liability without fault. I certify that there are no health-related reasons or problems which preclude my participation in the activities that take place at Interskate Roller Rink. I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for exhaustion, minor injuries, or even fatal injuries. In the case of any form of injury or issue, Interskate Roller Rink assumes no responsibility for bills or costs that arise from the paramedics, the transportation to the hospital, from the hospital itself, or further treatment. I acknowledge that this Interskate Roller Rink Accident and Release of Liability Waiver will be used by Interskate Roller Rink and that it will govern my actions and responsibilities at said activity. I acknowledge that Interskate Roller Rink is NOT responsible for errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I agree to follow all rules and dress-codes that are posted or stated by an employee while on the property of Interskate Roller Rink. I acknowledge that Interskate Roller Rink assumes no responsibility for any lost or stolen items on Interskate Roller Rink's property. The Participants and/or their parent/guardian acknowledge, understand, and agree that roller skating is an inherently dangerous and physically demanding activity. The Adult parent/guardian participant and their participating minors assume full responsibility for property damage, any risk of injury, or death while participating in activities at this establishment. Minor participants and/or their parent/guardian, whom may by participating as well, hereby waive any and all claims including, but not limited to, bodily injury (including death) and personal property damage they may have against Interskate Roller Rink, its parents, subsidiaries, partners, and affiliates. Furthermore, the minor participants and their parent/guardian, whom may be participating, hereby waive any and all claims including, but not limited to, bodily injury and personal property damage they may have against Interskate Roller Rink's sponsors and their subsidiaries, affiliates, partners, officers, directors, employees, agents, and volunteers from arising out of Participant's use of Interskate Roller Rink and all surrounding areas. Minor participants and the parent/guardian of the participants permit Interskate, its parents, subsidiaries, partners, and affiliates to use any photographs, videotapes, recording, or any other records taken while while on Interskate Roller Rink's property for publicity, advertising, or any other legitimate purpose, without compensation to the participant(s) and/or their parent/guardian. BY TYPING OR INSERTING MY NAME IN THE TEXT BOX BELOW, AS THE PARENT/GUARDIAN OF THE PARTICIPANTS AND/OR AS A PARTICIPANT MYSELF, I AGREE TO THIS RELEASE OF LIABILITY AND WAIVER OF ALL CLAIMS, I UNDERSTAND THAT I AM RELEASING INTERSKATE ROLLER RINK FROM ANY CLAIMS FOR NEGLIGENCE AND DAMAGES, AND AGREE TO THE OTHER TERMS IN THIS DOCUMENT. BY SIGNING I ALSO AGREE TO PAY FOR ANY DAMAGES CAUSED TO EQUIPMENT CAUSED BY ABUSE OR MISUSE IN A CASH AMOUNT OF NO LESS THAN $10.00 (THIS INCLUDES DAMAGES CAUSED BY SKATING ON SURFACES OF THE ROLLER RINK). I HAVE CAREFULLY READ THIS WAIVER, RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT IN ITS ENTIRETY AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK AGREEMENT AND A LEGAL CONTRACT BETWEEN ME AND INTERSKATE AND THAT IT AFFECTS MY LEGAL RIGHTS. I AM SIGNING THIS DOCUMENT OF MY OWN FREE WILL. A PHYSICAL AND ELECTRONIC COPY OF THIS DOCUMENT IS AUTHENTIC AND IS AS EFFECTIVE AS THE ORIGINAL AND DOES NOT EXPIRE. *

Please insert the name of the responsible adult below.

First Name

Last Name