Impact Skate Shop _ Park -1650 J

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					                     Impact Skate Shop & Park -1650 Jackson Ave Se, Port Orchard, WA 98366
                                                             (360) 895-0793

Primary Member Name (First,

D.O.B._____________ SEX (M) - (F)       Age:________                                  Home

Mobile Number 1 ( Name):_______________________
Mobile Number 2 (Name):___________________________

Street Address_________________________________ City__________________________ State______

Emergency Contact_____________________________ Phone________________________________

Parent / Guardian (First, Last):___________________________ Phone:_________________________

Email Address:

                                            Park Rules & Safety Protocol:
    No Smoking/ Drugs/ Or Alcohol anywhere on premises (Including Parking lot)
    No altering, defacing, destroying or removing establishment property ( Yes this includes spray painting the building)
    No cursing, spitting or littering
    No Skating or Skateboards/ Bikes/ Scooters in the parking lot areas
    No food and or beverages in the park area.
                                                    Safety Protocol :
    All participants under 18 years of age must wear skate -approved safety helmets while in the skating area at all
     times. Its your responsibility to wear the helmet with the appropriate certifications for your specific sport.
     Helmets can be rented at the sign in deck.
    Elbow & Knee Pads are required for anyone under 14 years old
    Elbow/Knee/ and Wrist Guards are HIGHLY RECOMMENDED
    Stay alert of your surroundings, Pay attention to other skaters and riders in the park
    Do not skate or ride where others are performing tricks. TAKE TURNS
    Avoid dangerous scenarios. Attempt tricks that you have proficiency at

X____________________________________                                   X____________________________________
    Applicant Signature (If under 18 Parent/ Guardian must also sign)                    Parent/ Guardian Signature
----------------------------------------------------------------------------------------------------------------------------- --------

Circle One:        (waiver)            (Retail membership)                  ( Basic Membership)                   ( Pro Membership)

                                                   FOR MEMBERSHIP ONLY
I agree to a minimum one year commitment, In agreeing to a one year contract I am locking in the membership price for one year and to start
from the date of this contract. I have read and understand this membership agreement. I have received a copy of the club rules and regulations and
the code of conduct. I agree and accept and signed Impact Skate Shop’s Liability waiver and I agree that I and all persons using the facility under
this membership are bound by and shall comply with the rules and regulations of the facilities services and accept that the facilities are in “as is”
condition. Anytime before you skate you should check the surface of the ramps and skate areas for any loose debris and or screws to the ramp
surfaces. I further understand that Impact Skate Shop shall not responsible for any lost, stolen or damaged personal property or the property of my
family or guest. I also under stand that this is NOT the waiver for the skate park and until I sign the waiver I can NOT skate in the park until said
waiver is signed.
Date:______________                                                              Date:______________

Applicant Signature (If under 18 Parent/ Guardian must also sign)           Parent/ Guardian Signature
                                  Impact Skate Shop & Park Skate Park & Comp Waiver
                           1650 Jackson Ave Se- Port Orchard, WA 98366-(360) 895-0793

                                      Agreement for Waiver and Release,
                                   Assumption of Risks & Indemnification
                       This document affects your legal rights. You should read it carefully.
                    No membership will be granted without proper completion of this document.

Skaters Name:____________________________ ______

Parent/ Guardian’s Name:________________________________________

I,_________________________ the above skater being above age 18, or parent/guardian of the above said person
who is under age 18, agrees as follows:
           I, acknowledge and understand that skating, in-line skating, skateboarding, riding scooters and other roller
sports are hazardous and understand that these activities can result in serious injury to the person and damage to
property and voluntarily assume and any and all risk of loss, damage or injury while on the premises. Impact is not
responsible for stolen, broken, damaged personal property. I am aware of the risks, hazards and dangers of personal
injury, death and disability inherent in entering the premises, as well as those inherent risks, hazards and dangers of
personal injury, death and disability in participating in any roller sport event. I am aware that the usual risks, hazards
and dangers of personal injury, death and disability increase when using ramps, curbs, stairs, steps, half pipes,
inclines, or declines, bowls or any others structure or device. I also understand that these risks, hazards and dangers
are further increases when other persons, whether of the same level of experience or skill, are using the same
facilities. In consideration for the admission, viewing privileges and use of the facilities of Impact Skateboards. I
hereby agree to release and forever discharge Impact Skateboards; CMBA No.4 LLC ( landlord), and Impact
Skateboards agents, servants, employees, officers, directors, trustees and all other persons or entities acting on their
behalf, from any and all claims, actions, damages, liability, cost or expenses and attorney fees and medical bills,
which are related to, arise out of, or are in away connected to my participation or use of the skate park facility (either
in the interior or the exterior), use of equipment or property supplied by Impact Skateboards or my presence upon
the premises, whether or not such claims, actions, damages, liability, cost or expenses are caused by the negligence
of Impact Skateboards or landlord. By this agreement, it is my intention to surrender and waive any rights to sure
or exercise any legal right to seek damages from Impact Skateboards, CMBA No.4 LLC, and their agents, servants,
employees, officers, directors, trustees, and all other persons or entities acting on their behalf.
           I acknowledge that my participation in or the viewing and spectating of activities at Impact Skateboards is
strictly voluntary in spite of the risks and dangers and that no one is forcing me to participate or view and spectate. I
am also aware that there is an inherent risk in simply being at impact skateboards and/ or observing, photographing
or videotaping the activities. I give my consent and permission to Paintball Depot dba as Impact Skate shop & park
to obtain on my behalf of myself or my minor child any emergency medical treatment in case of sickness, accident
or injury and to secure such medical attention at my expense. I agree that this agreement shall apply to my
participating / my Childs participation in any and all of impact skateboards activities and programs and skate
sessions, including but not limited to, open skating skateboarding, other roller sport activities, practice sessions,
skate lessons, competitions and activities directed by and representative of impact skateboards, including viewing or
spectating of any of the aforementioned activates. This agreement shall cover all of the aforementioned activities
regardless of whether the activities are conducted inside the building, outside the building, or at any other location
where activities arte sponsored by Impact Skateboards may take place. This agreement shall be effective and binding
upon my heirs, agents, personal representatives and assigns. This agreement does not expire.
           I hereby certify that I am over 18 years of age. If I am not over the age of 18, me and my parent/ guardian
agrees to the skate park waiver and I have carefully read the foregoing and acknowledge that I understand and agree
to all of the above terms and conditions. I have had the opportunity to ask any and all questions regarding this
agreement and the effect of the same. I am aware that by signing this agreement, I assume all risks and waive and
release certain substantial rights that I may have or posses. I understand by signing this agreement I am signing for
my own child and I hold guardianship for my child. I understand that if for any reason it is brought to our attention
we will and can release any information to the local law office/ parent guardian for anyone who signs for someone
who does not have guardianship for the person they are signing for.

  Signature of Skater              Date                         Parent/ Guardian ( if skater is
under 18)   Date

Skater- Parent / Guardian Drivers License Number#______________________________________

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