Samuel Powel Fall 2019 – Skate The Foundry

Step 1: Payment
Register your child for our After School Skateboard Program at Samuel Powel from HERE.
Register your two children for out program at Powel with 10% off sibling discount from HERE.
For three or more children, please email us (contactskatethefoundry@gmail.com)

Step 2: Registration Form
Once we receive your payment, we will send you the confirmation email. While waiting, please complete our skate waiver below.

School Name *

Name of Participant 1 *

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Last

Age/Grade of Participant 1 *

Name of Participant 2 (if any)

First

Last

Age/Grade of Participant 2 (if any)

Name of Participant 3 (if any)

First

Last

Age/Grade of Participant 3 (if any)

Name of Participant 4 (if any)

First

Last

Age/Grade of Participant 4 (if any)

Parent/Guardian Name *

First

Last

Parent/Guardian Birth Date (xx/xx/xxxx) *

Parent/Guardian Email *

Parent/Guardian Phone *

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Address of Participant (If different)

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Name *

Emergency Phone *

Risk Acknowledgement: I hereby authorize the staff at Skate The Foundry to act for me according to their best judgement in any emergency requiring medical attention, and I hereby waive any and all claims for personal injury, illness, and/or property damage that I may have against Skate The Foundry and its employees, contractors, representatives, interns, and any volunteers in any way associated with Skate The Foundry. I understand that participation in Skateboarding and all other after school program activities involving motion, rotation, and height in a unique environment, carries with it the risk of injury. Skate The Foundry is not responsible for personal items that are lost, stolen, or damaged. All medical expenses incurred will be the responsibility of the participant(s) or the participants' family. In lieu of a medical certificate signed by a medical doctor, I have no knowledge of any physical or mental impairment that would be affected by the named participant(s)' participation in the after school skateboard program, as outlined on our website, which I have read. I also expressly grant to the after school program and any third party authorized by the after school program the right to film, videotape, photograph, record the voice of and make any reproduction of the participant(s)' physical likeness and voice and the irrevocable right in perpetuity to use, display, and digitally enhance or alter in any manner, such likeness in any media now known or hereafter devised, including but not limited to the exhibition and/or online use, broadcast, theatrically, or on television, cable or radio, or any motion picture film, video tape, DVD, CD, or any published articles in which such likeness may be printed, used or incorporated, and in the advertising, exploiting and publicizing of the after school skateboard program, the program products, licensed products, and all affiliated relationships. *

I agree to the terms and conditions listed above.

Check to agree with terms below: *

By checking the box above I am signing this release of liability document below.

Skate Waiver - Parent/Guardian Sign Full Legal Name *

PARTICIPANT AGREEMENT, WAIVER OF SKATE THE FOUNDRY LIABILITY, AND ASSUMPTION OF RISK BY YOU THE PARTICIPANT OR THE PARENT OR LEGAL GUARDIAN OF ANY MINOR PARTICIPANT: I hereby agree to waive any and all liability, indemnify, discharge and hold harmless Skate The Foundry, their owners, agents, staff, volunteers, participants on behalf of myself, my children, my parents, my heirs, assigns, personal representative, or estate and acknowledge the following: Skateboarding, in-line skating, BMX bicycling, scooters, and related activities herein defined as “Action Sports” are inherently dangerous activities. Participation in action sports including mere presence or observing whether or not actually participating carries a serious risk of injury or even death. Skate The Foundry recommends use of helmets, pads and any other safety equipment appropriate for said activities. Failure to use safety equipment may increase your risk of injury. The risks include, but are not limited to: Collisions, my own equipment failure or the failure of others’ equipment; my own or others’ negligence; objects or conditions that may cause me to experience serious injury and even death. I expressly agree and promise to accept and assume all of the risks of this activity. My participation in this activity is purely voluntary, and I elect to participate with full knowledge of the risks and waiver of Skate The Foundry liability for those risks. 1. Any person who participates in or assists in skateboarding, inline skating, or freestyle or BMX bicycling assumes the known and unknown inherent risks in these activities irrespective of age, and is legally responsible for all damages, injury, or death to himself or herself or other persons or property which result from these activities. Any person who observes skateboarding, inline skating, or BMX bicycling assumes the known and unknown inherent risks in these activities irrespective of age, and is legally responsible for all damages, injury, or death to himself or herself which result from these activities. 2. While engaged in skateboarding, inline skating, freestyle or BMX bicycling, irrespective of where such activities occur, a participant is responsible for doing all of the following: (a) Acting within the limits of his or her ability and the purpose and design of the equipment used. (b) Maintaining control of his or her person and the equipment used. 3. Refraining from acting in any manner which may cause or contribute to death or injury to himself or others. 4. Failure to comply with the requirements of this paragraph shall constitute negligence by you the participant. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Skate The Foundry from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Skate The Foundry equipment or facilities, including any such claims which allege negligent acts or omissions of Skate The Foundry. IN THE EVENT LITIGATION ARISES OUT OF OR RELATING TO SKATE THE FOUNDRY FOUNDR ENFORCEMENT OF THIS WAIVER, OR IF ANY LEGAL ACTION IS INITIATED BY YOU ARISING OUT OF OR RELATED TO THIS WAIVER, YOU AGREE THAT SKATE THE FOUNDRY WILL BE ENTITLED TO RECOVER ITS REASONABLE ATTORNEYS' FEES, COSTS AND EXPENSES INCURRED IN INVESTIGATING, PREPARING FOR, PROSECUTING, DEFENDING AGAINST OR OTHERWISE LITIGATING ANY SUCH ACTION. I further certify that I am willing to assume the risk of any medical or physical condition I may have. In the event that I file a lawsuit against Skate The Foundry, I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By checking the box above I am signing this document and I acknowledge that if anyone is hurt or property is damaged upon entering Skate The Foundry or during my participation in this activity, I acknowledge my intention is to have waived my right to maintain a lawsuit against Skate The Foundry. Further, I may in fact owe to Skate The Foundry the reimbursement for Attorney Fees and costs incurred by Skate The Foundry. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

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