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					The Mill Skate and Bike Park (The Mill)                                                   Waiver & Medical
 Release FORM                                                                               2011

   1. Completely fill out this waiver form, have it signed by a parent or legal guardian and bring it with you to the
      Skate Park. We cannot accept signatures from friends, host-families, grandparents, aunts, uncles, stepparents
      of other relatives (without guardianship papers) because those signatures are not legally binding. If the Mill
      Skatepark does not witness the signatures below, we may deny access to our facilities. HELMETS ARE
      REQUIRED, BRING YOUR OWN, OR YOU MAY RENT. PADS are optional but recommended. If you
      are caught on the park without helmet on, you may be removed from the park!
   2. Bring ID to prove your age. We accept: Current school picture ID, Birth Certificate, Drivers License, DMV
      ID Card, and Medical ID card.
   3. Parents/Guardians, family and friends of participants are welcome to come and observe all our programs, but
      may not roll unless they have registered and paid. Participants at The Mill Skate Park under the age of 8 must
      have a parent or a guardian or a chaperone present in the Skate Park facility or on Mill excursions at all times.
   Last Name__________________________First______________________M.I._____Phone No. 1(                 )_____________________

   Birth date ____/____/_____Age______ Phone No. 2___________________emailaddress_____________________________
   Address___________________________________City______________________State____ ZIP_______________

   Does Skater/Biker/Participant have any Medical Conditions or Concerns: NO______YES: If so, plse explain__________________________________

   Do You give us permission to administer first aid in case of an injury:   NO_______     YES______

   We will transport skater/biker/participant to closest hospital for emergency care unless you make a hospital choice here:________________________

   1, THE UNDERSIGNED Parent or Legal Guardian or Participant that is 18 or older, do agree to indemnify The Mill Skate and Bike Park upon the
   reception of this acknowledge/agreement/waiver and hereby grant permission to the above named person to participate in activities and the Mill
   Skate and Bike Park with the following conditions, requirements and agreements;
   1. The Undersigned understands, acknowledges, and agrees that this Agreement applies whether the Participant is at the Park as an observer, a
   bystander, or an active participant, whether the activity is at the above stated premises, or on an OUTING, including TRAVELING to and from
   such activities.
   2. I understand that the Participant must obey and respect all the rules, volunteers and staff of the Park.
   3. The Undersigned understands, acknowledges, and agrees that skateboarding, in-line skate, biking, scooting, and other core sports are dangerous
   and can result in injury, death or personal property damage, and is fully aware of the risks and hazards inherent to such activities and hereby
   enrolls voluntarily the Participant, knowing the present condition of ramps, equipment, facilities, and property with full knowledge that the said
   condition may become more hazardous and dangerous at any time while the Participant is involved in/with The Mill Skate and Bike Park.
   4. The Undersigned hereby voluntarily assumes all risk of loss, theft, damage, injury, or death that may be sustained by the Participant and any
   damage to or theft/loss of his/her property while in The Park and understands that various degrees of experience and skill are required for the
   different ramps and riding surfaces and agrees that it will be the Participant’s sole judgment as to what the Participant will attempt to ride/do.
   5. In consideration and upon the reception of this Agreement, the Undersigned hereby releases The Mill Skate Park, on behalf of the above named
   Participant, his/her heirs, assigns, and legal representatives from any and all liability for personal injuries or property damages/theft/loss or death
   arising out of the Participant’s involvement, whether or not the said injuries, death, damages/loss/theft were caused by the negligent care of the
   facilities, ramps, equipment, observation areas or by the Organization’s Staff or entities in connection with any and all damages, losses, claims,
   rights, actions, and causes of action of whatever nature whether injuries, death, or damages/losses/thefts to the property of the Participant.

   _____________________________Date____/____/____ X_____________________________                                      Date _____/_____/_____
   Birth Parent/Legal Guardian Signature          OR Participant 18 or Older/Adult

   Printed Parent Name______________________ Emergency Contact Name_______________________

                                                                                        Phone (     )______________________