ADULT & PARENTAL CONSENT, MEDIA RELEASE AND WAIVER OF LIABILITY FORM
For Doomsday Skate LLC., skate lessons public & private, and the Everyone Rolls rental skates program by The SLORoll Community Initiative Inc.
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Email *
Legal Name *
Contact phone number? *
Emergency Contact Person/phone number *
Are there any injuries or health issues I should be aware of? (private info for my records only). *
EVERYONE ROLLS SKATE RENTAL RELEASE OF LIABILITY: *IF you do not need a rentals, please type NA and skip to next **

I UNDERSTAND THAT any equipment that I may rent from The SLORoll Community Initiative Inc. Everyone Rolls program I use at my own risk and that any such equipment is provided without any warranty of its condition and stability. I understand the injury risk of roller sports in public and private settings. If you agree, please type your legal name below.
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GENERAL LIABILITY: I understand that Doomsday Skate insurance REQUIRES me to wear a helmet, wrist guards and knee pads while skating on surfaces and terrain that may be deemed dangerous and or hazardous with Shauna Gustuson, Doomsday Skate LLC. If I choose for myself or my child to go unprotected I do so at my own risk.    *
FOR GOOD AND VALUABLE CONSIDERATION, including permission for myself and the minor(s) listed below ("Minor(s)") to skate and otherwise participate in related activities at DOOMSDAY SKATE LLC., Skate Instructors Association, Roller Threads Ltd and The SLORoll Community Initiative Inc. I, for myself, my successor, heirs, assigns, executors, and administrators, and as the parent/guardian of the Minor(s) on behalf of the Minor(s): 1. Agree that prior to participating in the event or activity, prior to providing consent to the Minor(s)'s participating in the event or activity, and prior to my participation and/or the Minor(s)'s participation in the event or activity, the Minor(s) and I will inspect the facilities, equipment, and areas where the event or activity is being conducted and, if either of us believes any of them are unsafe, I will immediately advise the person supervising the event, activity, facility or area; 2. Acknowledge that the Minor(s) and I fully understand that my participation and/or the Minor(s)'s participation may involve risk of serious injury or death, including economic losses, which may result not only from my or the Minor(s)'s own actions, in-actions, or negligence, but also from the actions, in-actions, or negligence of others, the condition of the facilities equipment, or areas where the event or activity is being conducted, the rules of play, or this type of event or activity ; 3. Forever release, waive, discharge and relinquish DOOMSDAY SKATE LLC., Skate Instructors Association, Roller Threads Ltd and The SLORoll Community Initiative Inc.  their respective officers, shareholders, members, directors, insurers, employees, and agents from any and all liability, loss, damage, claim, demand or cause of action brought against them attributable to my or the Minor(s)'s participation in the event or activity, whether same shall arise by their negligence or otherwise. Furthermore, I for myself, and/or the Minor(s), and my/their successors, spouses, parents, guardians, dependents, heirs, executors, administrators, and personal representatives, agree to indemnify, defend and hold the relinquish DOOMSDAY SKATE LLC., Skate Instructors Association, Roller Threads Ltd and The SLORoll Community Initiative Inc. their respective officers, shareholders, members, directors, insurers, employees, and agents harmless from any liabilities, losses, claims, demands, expenses or damages, including attorneys' fees and costs, sustained by any one or more of them, as a result of my and/or the Minor(s) participation in the event or any other activity associated therewith, including but not limited to those resulting from a rescission of this Agreement, a breach of my or the Minor(s)'s covenants or agreements contained herein, or negligence and/or willful misconduct. 4. Assume any and all risks of personal injuries to myself and/or the Minor(s) and relinquish DOOMSDAY SKATE LLC., Skate Instructors Association, Roller Threads Ltd and The SLORoll Community Initiative Inc. for any and all financial risk associated with this activity. If such medical treatment or hospitalization is required, I agree to pay all medical and hospital bills relating there to, and agree to pay all damages relating to my and/or the Minor(s)'s permanent or partial disability or death, and any other damages to me and/or the Minor(s), and any other damages to my or the Minor(s)'s property, caused by or arising from my participation or the Minor(s)'s participation in the event or activity; 5. Covenant not to sue or present any claim for personal injury, property damage, or wrongful death for or on behalf of myself or the Minor(s) against relinquish DOOMSDAY SKATE LLC., Skate Instructors Association, Roller Threads Ltd and The SLORoll Community Initiative Inc. or their respective officers, shareholders, members, directors, insurers, employees, or agents attributable to my or the Minor(s)'s participation in the event or activity; 6. Agree that photographs, pictures, slides, movies, or videos of myself and/or the Minor(s) may be taken in connection with my or the Minor(s)'s participation in the event or activity, and consent to the use of such photographs, pictures, slides, movies, or videos for any legal purpose, without compensation from relinquish DOOMSDAY SKATE LLC., Skate Instructors Association, Roller Threads Ltd and The SLORoll Community Initiative Inc. Further consent that my identity and/or the Minor(s)'s identity may be revealed either therein, or by description, text, commentary, or otherwise, and waive any and all rights, claims or interest in such photographs, pictures, slides, movies, videos, description, text or commentary, and understand that there will be no financial or other remuneration; 7. Warrant that I am in good health and the Minor(s) is (are) in good health and have no physical condition that would prevent me or the Minor(s) from participation in the event or activity; 8. Acknowledge that DOOMSDAY SKATE LLC. ,Skate Instructors Association, Roller Threads Ltd and The SLORoll Community Initiative Inc. are not joint sponsors, joint venturers, partners, or otherwise jointly engaged in the above named event or activity; 9. Agree to defend, indemnify, and hold harmless DOOMSDAY SKATE LLC., Skate Instructors Association, Roller Threads Ltd and The SLORoll Community Initiative Inc. from any and all claims, including attorneys' fees and costs, which may be brought against them, or any of them, or any of their respective officers, shareholders, members, directors, insurers, employees, or agents by anyone claiming to have been injured as a result of my and/or the Minor(s)'s participation in the activity. IMPORTANT: THIS DOCUMENT RELIEVES relinquish DOOMSDAY SKATE LLC., SKATE INSTRUCTORS ASSOCIATION, ROLLER THREADS LTD AND THE SLOROLL COMMUNITY INITIATIVE INC. AND OTHERS FROM ANY AND ALL LIABILITY FOR PERSONAL INJURY, WRONGFUL DEATH, AND PROPERTY DAMAGE CAUSED BY NEGLIGENCE. A PARENT OR LEGALLY APPOINTED GUARDIAN MUST SIGN. *
Required
Birthdates of skater/s *
What town are you driving from? (demographics for Doomsday Skate only) *
Required
Adult skater age (for Doomsday Skate only) *
Minor/s age (for Doomsday Skate only) *
A copy of your responses will be emailed to the address you provided.
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