Skate Night Disclaimer

As the parent/guardian of the skater/s named below, I give permission for my child/children to participate in Skate Night at the Harvey Recreation & Cultural Centre, Tom Latch Drive, Harvey WA.

I acknowledge that participation in Skate Night involves inherent risks, including the risk of injury, and that my child/children participate at their own risk.

The Shire of Harvey accepts no responsibility for injury, loss or damage arising from participation in Skate Night or use of the Centre, including injury caused by the participant, another participant or another person, or loss of or damage to personal property.

This disclaimer does not apply to the extent that injury, loss or damage is caused or contributed to by the wilful, negligent or unlawful act or omission of the Shire of Harvey or its employees, officers, agents or contractors.

Parent/Guardian Full Name

First NameLast Name

How many skaters are included in this waiver?

Skater 1: Full Name

First NameLast Name

Skater 1 Date of Birth

Date

Photo permission. Do you consent to photo/video being taken of Skate 1?

Skater 2: Full Name

First NameLast Name

Skater 2 Date of Birth

Date

Photo permission. Do you consent to photo/video being taken of Skate 2?

Skater 3: Full Name

First NameLast Name

Skater 3 Date of Birth

Date

Photo permission. Do you consent to photo/video being taken of Skate 3?

Skater 4: Full Name

First NameLast Name

Skater 4 Date of Birth

Date

Photo permission. Do you consent to photo/video being taken of Skate 4?

Skater 5: Full Name

First NameLast Name

Skater 5 Date of Birth

Date

Photo permission. Do you consent to photo/video being taken of Skate 5?

Parent/Guardian Signature

Today's Date

Date

Skate Night Participation Disclaimer