Waiver

SKATE Ministry Waiver- ANXIOUS FOR NOTHING Valid for 1 year from Date Signed

 

Participants Name__________________________________________________   Date _____________

Age______________

DOB__________________

Parent(s) Name __________________________________________________

Parents Phone Number___________________________________________

Email Address___________________________________________________

Address__________________________________________________________________________________________________________________________________________________________

Emergency Contact____________________________________________________

____________________________________________________________________________

Medical Conditions_________________________________________________________________

 

I hereby authorize the staff and volunteers of Anxious for Nothing INC.  to act for me according to their reasonable judgment in any emergency requiring medical attention. I acknowledge that participation in athletics carries with it a risk of physical injury, I agree that Anxious for Nothing INC, its agents, employees, staff, volunteers , Blue Ridge Community Church or any of its assignees or other successors in interest, shall not be liable to me or the student/participant for any injury or damage, whatsoever caused, resulting directly or indirectly from the student or my participation in Anxious for Nothing INC skateboarding/Scootering  at any time preceding, during, or after the session and I hereby discharge and shall indemnify Anxious for Nothing INC, its agents, employees, staff, volunteers , Blue Ridge Community Church or any of its assignees or other successors from all actions, claims, and demands the student or I may have for any such injury or damage. All medical expenses incurred will be the responsibility of the participant or the participant’s parent or guardian. I have no knowledge of any physical or mental impairment that would affect the student’s or my participation in skateboarding/scootering.

 Student/Participant Signature:                                                                                    Date:

Parent/Guardian Signature:                                                                                         Date:

 

PLEASE READ: No matter how careful the participants and the instructors are, no matter what safety equipment is used and worn, and what precautions are taken, there is an inherent risk that cannot be eliminated. The risk of injury includes minor injuries such as bruises, scrapes, and more serious injuries such as broken bones, dislocations, sprains, and catastrophic injuries such as permanent paralysis or even death due to falls on the back, neck or head.

Parents/Guardians Print Name_____________________________________________ Date _________

Parents/Guardians Signature___________________________________________ Date ___________