Blue Skate LLC

Adult or Parent Name

First NameLast Name

For participant of minority age (under age 18 at time of registration)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agreeto his/her release as provided above of all Releasers, and, for myself, my heirs, assigns, and next of kin, Irelease and agree to indemnify and hold harmless the Releasers from any and all liabilities incident to myminor child’s involvement or participation in these programs as provided above, EVEN IF ARISINGFROM THE NEGLIGENCE OF THE RELEASERS, to the fullest extent permitted by law.

Child's Name & Birth Date

Phone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

In consideration of permission to use today and on all future dates, athletic/sports program, related events and activities, I, the undersigned (Skater or spectator), hereby expressly agree:

1) The risk of injury from the activities involved in this program is significant, including the potentialfor permanent paralysis and death. And while particular rules, equipment and personal disciplinemay reduce this risk, the risk of serious injury does exist;

2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVENIF ARISING FROM THE NEGLIGENCE OF THE RELEASERS or others. And assume fullresponsibility for my participation

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

4)I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBYRELEASE AND HOLD HARMLESS BLUE SKATE LLC their officers, officials, agents, and or employees, whether paid or not, other participants, sponsoring agencies, sponsors, advertisers and if applicable, owners and lessors of premises used to conduct the event(“Releasers”). WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property. WHETHER ARISING FROM NEGLIGENCE OF THERELEASERS OR OTHERWISE

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISKAGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVENUP SUBSTANTIAL RIGHT BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILYWITHOUT INDUCEMENT.

Email

example@example.com

Date Signed

Date

Booking ID

Session ID

Signature