REGISTRATION - UTAH SKATING ACADEMY
CLASSES AND COMPETITIVE TEAMS
DATE OF BIRTH AGE ON JANUARY 1
MAILING ADDRESS/STREET OR PO BOX
CITY ZIP CODE
ACCIDENT WAIVER AND RELEASE OF LIABILITY
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ROLLER SKATING AT TAYLORSVILLE FITNESS AND RECREATION CENTER, TAYLORSVILLE, UTAH, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.
I certify that I am physically fit, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.
In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, the following entities or persons: the owners, directors, officers, employees, volunteers, coaches, teachers, representatives, and agents;
(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in the sport of roller skating, whether caused by the negligence of release or otherwise.
I acknowledge that representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.
I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of activities of the Utah Skating Academy. These risks are not only inherent to participants, but are also present for volunteers.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during participation in activities of the Utah Skating Academy.
I understand while participating in the sport of roller skating, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.
The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
No further documentation is required for class participation. A copy of a certified birth certificate and social security number are required for membership on the Competitive Teams