WAIVER AND RELEASE OF LIABILITY

[Read before Signing]

BY SIGNING THIS DOCUMENT, YOU ASSUME ALL RISKS AND WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

NAME OF PARTICIPANT: ____________________________________ AGE: ______

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DATE OF BIRTH____/____/____ GRADE IN SCHOOL (if applicable) _______

ADDRESS: _____________________________________

CITY: _____________________, STATE: ______________ ZIP CODE: ____________

E-MAIL______________________________________PHONE ___________________

WARNING!!!!

In consideration for use of services, facilities or equipment on said premises, the Participant hereby releases The Powerhouse Youth Center and Skateprk and Dover Bethany United Methodist Church., it’s subsidiaries, affiliates, partners, officers, directors, employees, agents, sponsors and volunteers (and each of their respective heir, assigns and legal representative) on behalf of the Participant or his or her heirs, assigns and legal representatives, from any and all liability for negligence, bodily injuries, death, or property damage to Participant arising out of the Participant’s use of or presence upon the property of The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church.

The Participant at The Powerhouse Youth Center and Skatepark understands, acknowledges and agrees that skating and skateboarding are dangerous activities. Those activities can result in injury to the person or Damage to the property or to Third Parties and the Participant is fully aware of the risks inherent in engaging in or observing any activities at the The Powerhouse Youth Center and Skatepark.

No matter how careful the Participant and staff are, no matter what safety equipment is worn, the risk cannot be eliminated.

The risk of injury includes minor injuries such as bruises and more serious injuries such as broken bones, dislocations and muscle pulls. The risks include catastrophic injuries such as permanent paralysis or death from landings or falls on the back, neck, or head. The Participants may suffer such injuries while merely observing or being in proximity to park activities as other Participants may collide, land or fall upon you. The Participant is aware of the condition of the Park and those conditions may become more dangerous during the time that the Participant is using the premises. The Participant voluntarily assumes all risk of loss, damage or injury while on the premises. The Participant acknowledges that there are various degrees of skill and experience required for the different activities and the Participant will therefore abide by the rules for use of the various park activities, including of wearing all protective gear and equipment that is required for the Participant and will follow the instructions of all Staff Members. Failure to follow rules and instructions from staff may result in termination of participation in activities.

The Participant agrees to indemnify The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church. against and save it harmless from any and all damages, actions, claims, judgements, costs of litigation and attorney fees which may result from the Participant’s use of, or presence upon, the property or Facilities of The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church, including damage to the equipment of the The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church when damage is attributed to malicious behavior.

I hereby authorize the staff at The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church. to act for me according to their best judgment in any emergency requiring medical attention. All medical expenses incurred will be the responsibility of the Participant or the Participant’s family. I certify to The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church, that I have no physical conditions or mental impairment that would be effected by the participation in the activities of the The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church.

I agree that this agreement shall apply to my participation in any and all The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church activities and programs, including, but not limited to open skating, skateboarding practice sessions, instructional sessions, competitions and activities directed by any representative of The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church. This agreement shall apply to all my future visits to the The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church..

________I permit ________ I do not permit The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church to use any photographs, videotapes, motion picture, recordings or any other records taken while I am on the premises of The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church. engaged in any activity or event sponsored, promoted, or organized by The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church for publicity, advertising or any legitimate purpose.

BY SIGNING THIS WAIVER AND ASSUMPTION OF RISK AND RELEASE, I ACKNOWLEDGE ITS CONTENTS, I AGREE TO BE BOUND BY THE TERMS OF THE RELEASE AND UNDERSTAND THAT ANY AND ALL RISK, WHETHER KNOW OR UNKNOWN ARE EXPRESSLY WAIVED IN ADVANCE. I CERTIFIY THAT MY PARTICIPATION IS COVERED BY INSURANCE TO COVER ANY INJURY OR DAMAGES I MAY SUFFER OR CAUSE, OR ELSE I AGREE TO BEAR THE COST FOR SUCH INJURY OR DAMAGE TO MYSELF FOR OTHERS. I HAVE SIGNED THIS DOCUMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Age: ______ Date Signed: _____/_____/_____

Participant’s Signature: ________________________________

FOR PARTICPANTS OF MINORY 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. I release and agree to indemnify The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church. and its lessor facilities from all liabilities incident to my minor child’s involvement or participation in the programs provided above, even IF ARISING FROM THE NEGLIGENCE OF The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church. to the fullest extent permitted by the law.

PARENT/GUARDIAN’S NAME:_________________________________________

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PARENT/GUARDIAN’S SIGNATURE: _____________________________________

EMERGENCY PHONE #: ( ) -

DATE SIGNED: ________/________/___________

SAFETY GEAR

YOU MUST ALWAYS (REQUIRED) WEAR THE FOLLOWING SAFETY GEAR AT The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church

a. Helmet: helps prevent injury to all areas of the head. Must be buckled and fit properly. Helmets must be approved by any well-known organization (like the Pro-Tec models).

b. Knee Pads: used as the first point of dispersion for impact forces during a fall, a skater should first drop to their knees. Pads must be securely strapped around the leg to avoid coming off while sliding.

c. Elbow Pads: gives protection in backward and sideways falls.

1. WE HIGHLY RECOMMEND THAT YOU WEAR THE FOLLOWING SAFETY GEAR AT The Powerhouse Youth Center and Skatepark and Dover Bethany United Methodist Church

a. Wrist Guards: skaters who lose their balance should try to fall forward. Wrist Guard protection promotes sliding, thereby distributing the impact of the fall.