Teen Skate Night
Paradise Skate - September 10th (Thursday) Ages 12-15 will skate from 4:30pm-6:00pm Ages 16-18 will skate from 6:00pm-7:30pm
Get ready to roll! You're invited to Teen Skate Night at Paradise Skate in Antioch. This event is open to ages 12-18 and includes free skate rentals, food, and admission. Rest assured, adult supervision will be provided throughout the event. We look forward to seeing you there!
Please be advised: A parent/guardian signature is required for sign-out at the conclusion of the event. Please come to the front entrance to sign out. Should you have any inquiries or concerns, please contact youth@antiochca.gov.
Youth Name:
*
First Name
Last Name
Parent/Guardian Phone Number:
*
Format: (000) 000-0000.
Parent/Guardian E-mail:
*
example@example.com
Birth Date:
*
-
Month
-
Day
Year
Date
Age:
*
What school do you attend? :
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contacts:
*Please fill out who we could contact incase of an emergency.
1. Parent/Guardian Name:
*
First Name
Last Name
Parent/Gaurdian Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email:
*
example@example.com
2. Parent/Guardian Name:
First Name
Last Name
Parent/Gaurdian Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email:
example@example.com
Allergy Information:
* Please include any allergy or dietary restrictions.
Do you have any allergies or dietary restrictions? If so, please list them down below and include what steps to take when encountering an allergic reaction:
*
Designated Pick-up Information:
*Please note: Youth will be released to parent/guardians, or designated pick-up adults only.
1. Designated pick-up Name:
*
First Name
Last Name
Designated Pick-up Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
2. Designated pick-up Name:
First Name
Last Name
Designated Pick-up Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
General Liability Release & Waiver
Please read this entire document. Write your name or the name of your organization as indicated and sign in the appropriate space at the bottom as the representative of yourself, your organization, and related participants.
General Liability Release & Waiver
By participating in this City of Antioch activity/event, I acknowledge that I have read and understand all event rules and requirements. I voluntarily assume all risks associated with participation and release, waive, and hold harmless the City of Antioch, its officers, employees, and agents from any liability for injury, death, or property damage arising from my participation. I agree to comply with all event regulations, accept responsibility for any individuals participating as part of my entry, and authorize emergency medical treatment if necessary at my expense. I certify that I and any participants associated with my entry are physically able to participate safely. I also grant permission for photographs, videos, or recordings taken during the event to be used by the City of Antioch for promotional, educational, or informational purposes.
*
I have read and understand this waiver.
Submit
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