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Skate Park Registration Form

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									                                  Eden Parks & Recreation
                                   Skate Park Registration



NAME: _______________________________________________________________________

DATE OF BIRTH:_______________AGE: _____

ADDRESS: ___________________________________________________________________

HOME PHONE NUMBER:________________                CELL PHONE NUMBER: ______________

If under 18:

MOTHER’S NAME/PHONE #s: ___________________________________________________

FATHER’S NAME/PHONE #s: ___________________________________________________

Do you have health and accident insurance? Yes:_______             No:________

If yes, company name and policy number: ________________________________________

If no, I understand that the City of Eden is not responsible for any injury that may occur as
a user of the Skate Park at Freedom Park.



Please list any illness or allergies that we should be aware of:

____________________________________________________________________________

Are you allergic to any medicines, pills, etc? ______________________________________

In case of emergency, notify:

__________________________________ Phone #s: ________________________________

__________________________________ Phone #s: ________________________________

__________________________________ Phone #s: ________________________________


____________________________________________________                    ___________________
               Signature of Skate Park user                                    Date


AND - If under 18:


____________________________________________________                    ___________________
              Signature of Parent or Guardian                                  Date
                                  Waiver and Release of Liability
                                           Skate Park


DISCLAIMER: THE CITY OF EDEN, ITS AGENTS, OR EMPLOYEES ARE NOT RESPONSIBLE
FOR ANY INJURY (OR LOSS OF PROPERTY) TO ANY PERSON SUFFERED WHILE
PLAYING, PRACTICING, OR IN ANY OTHER WAY USING THE SKATE PARK AT FREEDOM
PARK FOR ANY REASON WHATSOEVER, INCLUDING ORDINARY NEGLIGENCE ON THE
PART OF THE CITY OF EDEN, ITS AGENTS, OR EMPLOYEES.

In consideration of my participation, I hereby release and covenant not to sue the City of Eden,
its agents, employees, Mayor, Councilpersons, instructors, or coaches, from any and all present
and future claims resulting from ordinary negligence on the part of the City of Eden or
others listed for property damage, personal injury, or wrongful death, arising as a result of my
engaging in or receiving instruction in the activities or any activities incidental thereto, whatever,
whenever, or however the same may occur. I hereby voluntarily waive any and all claims
resulting from ordinary negligence, both present and future, that may be made by me, my
family, estate, heirs, or assigns.

Further, I am aware that skating and skate boarding are vigorous activities involving severe
cardiovascular stress and violent physical contact. I understand that skating and skate boarding
involve certain risks, including but not limited to, death, serious neck and spinal injuries resulting
in complete or partial paralysis, brain damage, and serious injury to all bones, joints, muscles, and
internal organs. I further understand that skating and skate boarding involve a particularly high
risk of knee, head, and neck injury. In addition, I understand that participation in skating and
skate boarding involves activities incidental thereto, including, but not limited to, the possible
reckless conduct of other participants. I am voluntarily participating in this activity with knowledge
of the danger involved and hereby agree to accept any and all inherent risks of property damage,
personal injury, or my death.

I further agree to indemnify and hold harmless the City of Eden, its agents or employees and
others listed for any and all claims arising as a result of my engaging in or receiving instruction in
skating or skate boarding activities or any activities incidental thereto, wherever, whenever, or
however the same may occur.

I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of
North Carolina and agree that if any portion is held invalid, the remainder of the waiver will
continue in full legal force and effect. I further agree that the venue for any legal proceedings shall
be in North Carolina.

I affirm that I am of legal age and am freely signing this agreement to participate in skating and
skate boarding at the Skate Park at Freedom Park. I have read this form and fully
understand that by signing this form, I am giving up legal rights and/or remedies which may
be available to me for the ordinary negligence of the City of Eden, its agents or employees or any
parties listed above.




____________________________________________________                         ___________________
               Signature of Skate Park user                                         Date


AND - If under 18:


____________________________________________________                         ___________________
              Signature of Parent or Guardian                                       Date
                            Eden Parks & Recreation
                               Skate Park Rules
The Skate Park is an unsupervised recreation area, and in order to provide and
maintain a safe and fun environment for the users of the Skate Park, the following
rules will be enforced at all times:

      All skaters must have registration cards.
      Safety equipment must be worn at all times – this includes, but is not limited to, a
       helmet, knee pads, elbow pads and shoes.
      Skateboards must be in good working condition.
      Only one person per skateboard.
      Only one skater on a ramp at a time.
      Skateboards and skating allowed in designated areas only.
      No personal ramps permitted.
      Skating permitted during designated hours only.
      Skate Park is closed during inclement weather.
      No bicycles permitted in Skate Park area.
      No food or beverages allowed in Skate Park area.
      No glass containers allowed in Skate Park area.
      Reckless or dangerous skaters will be requested to leave the skating area and
       premises immediately.
      All injuries must be reported to the City of Eden immediately.

Parks & Recreation staff, along with the Eden Police Department, will be making
periodic visits to the Skate Park to ensure all rules are being followed.

Individuals not following the rules will be asked to leave – and could be subject to
punishment of a Class 3 misdemeanor and fined no more than $500.

Skate Park hours are:

December – March
Monday – Saturday, 10 a.m. to 5 p.m.
Sunday, 1 to 5 p.m.
April – October
Monday – Saturday, 10 a.m. to 8 p.m.
Sunday, 1 to 8 p.m.

For more information, contact Parks & Recreation at 623-2110.


I have read the above rules for use of the City of Eden’s Skate Park at Freedom Park.
By signing this form, I agree to abide by the rules and acknowledge that by failing to do
so, I risk losing the privilege of using the Skate Park.



________________________________________________ ____________________
                   Signature of Skate Park user                            Date

								
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