HIBBING: Rolling Skate Rental LLC Roller Skating Waiver Form

Roller Skating Waiver Form

Please complete this form to participate in roller skating activities and acknowledge the waiver agreement, Hibbing Memorial Building Location.
Your Details (Parent and/or Guardian)

First NameLast Name
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Me and Minor(s)
Minor(s)
SAFETY ORIENTATION: Please read and check all boxes. By checking each box you acknowledge you read:
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
WAIVER AND RELEASE FROM LIABILITY

THIS AGREEMENT RELEASES VALUABLE RIGHTS. READ IT CAREFULLY AND COMPLETELY.

On behalf of myself, my estate or heirs and any other person who may have a claim as a result of my death, injury or disability (all hereinafter “Releasor”), hereby FOREVER RELEASE, DISCHARGE AND COVENANT NOT TO SUE Rolling Skate Rentals LLC in partnership with Hibbing Recreation Department (City of Hibbing) and any of his/her/their/its directors, officers, employees, volunteers, insurers and agents (all hereafter “Releasee”), from any and all liabilities, claims, demands, or causes of action that I may hereafter have for injuries or damages arising out of my participation in Roller Skating including but not limited to losses caused by the passive or active negligence of the releasee.

Releasor understands and acknowledges that the activities of Roller Skating have inherent dangers that cannot be eliminated. RELEASOR EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISK OF PERSONAL INJURY, PERMANENT DISABILITY OR DEATH sustained while participating/ observing/ attending in Roller Skating including the risk of passive or active negligence of the releasee or any other participant.

Releasor acknowledges and fully understands that each participant, including Releasors will be engaging in activities that involve risk of serious injury, including permanent disability and death, and that social and economic losses may result not only from Releasor’s own actions, inactions or negligence, but also from the actions, inactions of negligence of others notwithstanding the rules of play or the condition of the premises and any other equipment used. Risk associated with the activities of Roller Skating include but are not limited to minor injuries: scrapes, bruises, abrasions and contusions, Skeletal and Soft Tissue: Fractures or breaks, sprains, strains, dislocations, and ligament/tendon tears, Severe Injuries: Concussions and other head injuries, back and neck injuries, spinal cord damage permanent paralysis or disfigurement, Fatalities: Recognition that participation can result in death

Further, Releasor acknowledges and fully understands that there may be other risks not known or not reasonably foreseeable at this time. Releasor is financially responsible for any medical treatment/burial costs/financial costs attributed to any loss of life as a result of an accident/ injury/ or death. Indemnification and Hold Harmless: Releasor agrees to pay for the facilities legal defense cost if they or their guests cause lawsuit. Releasor acknowledges and fully understands any participant collisions accidental/ non-accidental contact with other skaters, spectators, attendees, Releasees on or off the rink, on the premises of Hibbing Memorial Building assumes all inherent risk.

If any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity, legality, and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

The undersigned, does hereby represent that he/she is the parent or legal guardian of participants’ and acting in such capacity agrees to the terms and conditions of the above stated waiver and release.

****DO NOT SIGN UNLESS YOU HAVE READ THIS AGREEMENT****
By signing below, I acknowledge that I have read and understood the waiver and release of liability agreement and agree to its terms.
Should be Empty: