Robbie & Dan Martin
595 Rabon Circle
Elgin, South Carolina 29045
(First) PLEASE PRINT (Last)
PHONE: (Home) _________________ (Cell) _________________ (Work) ______________
PRIMARY GUARDIAN: ____________________________________
PHONE NUMBERS: (Home)______________________(Cell)__________________________
I acknowledge that by signing this document I am releasing Robbie, Dan and/or Ryan Martin
from liability. Skating will be at my own risk. Any and all injuries that result are my own
responsibility. The homeowner/park owner will not be held liable. This release form has legal
consequences. I have read it carefully before I signed it. I acknowledge that I choose to
participate in the activity of skateboarding at “The Playground” half pipe.
I certify that I am in good enough physical condition to participate at The Playground. In
consideration of the opportunity to participate, I HEREBY RELEASE, DISCHARGE, HOLD
HARMLESS, PROMISE NOT TO SUE, SHALL DEFEND AND INDEMNIFY Dan, Robbie
and/or Ryan Martin (The Playground), its officials, from any and all rights and claims, including
claims arising from the negligence of the released parties, which may be sustained by directly or
indirectly in connection with my participation at The Playground. The undersigned further
acknowledge and agree that this release and indemnity shall be construed to be as broad and
Inclusive as permitted by law and that if any provision or portion of this release and indemnity is
held to be invalid by a court of competent jurisdiction, the undersigned agrees that the remainder
of this release and indemnity shall remain in full force and effect.
Participant: ______________________________ Date: _____________________________
I am the parent and/or guardian of ______________________________________________
Child – Participant
I have observed and made an inspection of The Playground Park. My child is fit for
participation. I consent to my child’s participation. I have read and understand the release and
indemnification set forth above. In consideration of allowing my child to participate, I consent
and agree that the terms shall likewise bind me, my child, my heirs, legal representative and
assignees. I hereby release, discharge and shall defend, indemnify, and hold harmless the release
parties form every claim and liability that I or my child may allege against released parties as
direct or indirect result of injury to me or my child because of my child’s participation at The
Playground Park, whether caused by the negligence of the released parties or others.
Parent or Guardian: ___________________________________ Date: ____________________
If participant is under the age of 18 (eighteen) years old a parent or guardian must sign this form.
Signature of participant is only required if 18 or over.
Please have form notarized if you will not be present to sign.