NATIONAL SKATE PARK, INC 
(Please print this form, fill it out, and bring it with you on your first visit) 

Name:___________________________________________________________ 

Street Address:__________________________City, State: ________________________Zip Code_________ 

Home Phone(s): (___)________________(____)_______________ Date Of Birth: _____/_____/_____ 

Emergency Contact Person: ___________________________________________ 

Emergency Number(s): (______)_____________________ (_______)________________________ 

Skateboard: Beginner: ___ Intermediate: ___ Advanced:___ 

AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY 
Read Before Signing 

In consideration of being allowed to participate in any way in the NATIONAL SKATE PARK, INC athletic/sports program, related
events and activities, I, _______________________________________ (Name of Participant), the undersigned acknowledge,
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 this risk, the risk of serious injury does exist:
and,


2.) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known 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, I 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, representatives and next of kin, HERBY RELEASE AND HOLD HARM
LESS NATIONAL SKATE PARK, INC., 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
("Releasees") WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property,
WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.


I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS,
UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY
WITHOUT ANY INDUCEMENT.


X ______________________________________________
PARTICIPANTS SIGNATURE
AGE:_________ DATE SIGNED: _______________________


FOR PARTICIPANTS OF MINORITY AGE


(UNDER AGE 18 AT THE TIME OF REGISTRATION) 

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as 
provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnity the 
Releasees from any and all liabilities incident 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 law. 

X _____________________________________________________________________ 
PARENT/GUARDIAN'S SIGNATURE 

EMERGENCY PHONE # (_______) _________________________ 

X RELATIONSHIP TO MINOR PARTICIPANT:____________________________________