2013 Summer at the Skatepark Email: summerattheskatepark@gmail.com 2101 – 6th Avenue, Castlegar, BC. V1N 3B2 BY ACCEPTING AND SIGNING THIS AGREEMENT BELOW, YOU AGREE, WARRANT AND COVENANT AS FOLLOWS: I ______________________________________________________________________ Parent/Guardian Name
________________________________________________________________________ City
Street
Postal Code
Hereby give my authorization for my child ___________________________________________________ Child’s Name Age To participate in 2013 Summer at the Skatepark with Kootenay Family Place – Castlegar ______ Check if Repeat Participant I understand my child ______________________________________to be medically able to participate and that he/she will be properly supervised. In consideration of the acceptance of this agreement, I assume full and complete responsibility for any injury or accident which may occur to my child during the activity and or event, or while I or my child is on the premises of the activity and or event. I also am aware of and assume all risks associated with participating in this activity and or event for my child, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the road. I, for myself, my child/children and my heirs and executors, hereby waive, release and forever discharge Kootenay Family Place and Castlegar & District Recreation Centre, and each of their agents, representatives, successors and assigns, and all other persons associated with the activity and or event, for my all liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my child’s participation in this activity and or event. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise. Severability. If any provision of this Liability Waiver shall be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Liability Waiver and shall not affect the validity and enforceability of any remaining provisions. Date Signed:___________________________________________________________________________ Parent/Guardian Name:__________________________________________________________________ _ Parent/Guardian Signature:________________________________________________________________ Witness Name:_________________________________________________________________________ Witness Signature:_______________________________________________________________________ Ty Smith, Coordinator, 2013 Summer at the Skatepark Sponsored by: Kootenay Family Place, PO Box 3144, Castlegar, BC. V1N 3H4 (250) 365-8448 Funded by: Province of British Columbia – Community Gaming Grant & Columbia Basin Trust