VIEWS: 23 PAGES: 3 POSTED ON: 12/1/2009
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
"Skate Park Registration Form"