Clone of Move United-Ability Skateboarding

Registration and Liability Waiver
On December 12th from 10am-12pm the Lee and Joe Jamail Skatepark will be activated for an adaptive skateboarding clinic. Join us for a day of action at the skatepark.103 Sabine St, Houston, TX 77007

Please complete the registration below. If you have any questions please reach out via email at Info@abilityskateboarding.org or call (210)514-8958.
What is your/or your child's name?
What is your/or your child's diagnosis/disability?
What is your/or your child's Date of Birth?
What is your/or your child's gender?"
What is your/or your child's ethnicity?"
Do your/or your child have any medical restrictions from the pediatrician or primary doctor?
What information would you like to share that will help the coaches and volunteers work well with you or your child?
What is parent/guardians physical address?
What is parent/guardians physical address?
What is your or parent/guardian email address?
What is parent/guardians name?
What is your or parents/guardian phone number?
Please note that as Move United Member Oragnization your registration information will be shared with Move United. https://moveunitedsport.org/
Rider Liability Release The undersigned hereby agrees to the following: 1. Assumption of Risk: I am the participant, Participants parent or legal guardian and, for myself and on behalf of said participants, I am aware of, understand, and assume the unavoidable risks of the inherently dangerous activity of skateboarding, which involves movement and physical exertion that could result in, but not be limited to, severe bodily injury or death. 2. Release of Liability: In consideration of Ability Skateboarding Inc. (“Ability Skateboarding”), its affiliates, {{Host Name}}, and {{Facility Name}} allowing the above named Rider’s and MY participation in the Clinic, I, for myself and on behalf of said participant, our heirs, administrators, personal representatives or assigns, hereby agree to release, indemnify, hold harmless and discharge Ability Skateboarding, its owners, agents, employees, officers, executives, directors, representatives, affiliates, assigns, {{Host Name}} and {{Facility Name}} and their volunteers, agents, employees, and officers of and from all claims, demands, causes of action, and liability, whether the same be known or unknown, anticipated or unanticipated, even if caused, in whole or part, BY THE NEGLIGENCE OF ANY OF THE FOREGOING. I further agree that I shall not bring any claims, demands, legal action and causes of action, against Ability Skateboarding and/or any of the foregoing for any economic and non-economic losses due to bodily injury and/or death and/or property damage, sustained by said Participant or ME in relation to the facility and/or operations of the Clinic, which shall include, but not be limited to, riding, driving, training, handling, or otherwise being near both conventional four-wheeled skateboards as well as the adapted and/or modified skateboarding equipment used by Ability Skateboarding at the facility during the Clinic, whether or not such skateboards and equipment are owned by Ability Skateboarding, or in the care, custody, or control of Ability Skateboarding. 3. Indemnification: If, despite this release, I, the above named Participant or anyone on said Rider’s behalf makes a claim against Ability Skateboarding or any of the foregoing, I agree to indemnify and hold harmless Ability Skateboarding and the foregoing from any litigation expenses, attorney’s fees, loss, liability, damage, or cost that they may incur due to the claim(s) made against Ability Skateboarding and the foregoing related to any of the activities or associated activities outlined above. Further, I hereby expressly acknowledge that photographs and/or videos of said Participant could be taken by parties outside the control of Ability Skateboarding and {{Host Name}} and {{Facility Name}} in connection with participating in the Clinic. I acknowledge that Ability Skateboarding and {{Host Name}} and {{Facility Name}} have limited or no control over such activities of third parties and have no control over any editing and/or use of such photos and/or video footage. I understand that data collected from this program will be used to help the clinic operate effectively relative to appropriate progressions, skateboarding and behavior management. I acknowledge that I may be contacted in the future for follow up information pertaining to rider progress, status or for other requests to support the future development and success of the program. Self or Parent/Legal Guardian Signature_ By typing my name below, I acknowledge that this is and will be considered my electronic signature. First Name Last Name
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Registration and Liability Waiver