PRINT NEATLY AND CLEARLY
705 W. KENNEDALE PKW. KENNEDALE, TEXAS 76060 PHONE 817-478-4500
PARTICIPANT AGREEMENT, RELEASE, AND ASSUMPTION OF RISK
In consideration of the services of Beau Emerson Enterprise LLC, Beau’s Skatepark, R&A,Inc. and any parties doing business on the premises, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity of their behalf (hereinafter collectively referred to as “BS”), I hereby agree to release, indemnify, and discharge BS, on behalf of myself, my children, my parents, my heirs, assigns, personal representative, and estate as follows:
1. I acknowledge that my participation in skateboarding, in-line skating, or other activities or sports known as dangerous but not mentioned above entails known and unanticipated risk that could result in physical or emotional injury, paralysis, death, or damage to myself to property, or to third parties, I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
THE RISK INCLUDE, AMONG OTHER THINGS: Collision with other participants, the walls, or other fixed objects; falling down; my own equipment failure or the failure of others’ equipment; my own or others’ negligence; and objects or conditions on the surface that may cause me to fall; broken bones, sprains, head and back injuries, abrasions, bruises, loss or impairment of vision, damage to teeth, damage to internal organs, loss of limb, paralysis and death. Furthermore, BS employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant’s fitness or abilities. They may give inadequate warnings or instructions, and the equipment being used might malfunction.
2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risk.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless BS from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of BS’s equipment or facilities, including any such claims which allege negligent acts or omissions of BS.
4. Should BS or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage to myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.
6. In the event that I file a lawsuit against BS, I agree to do so solely in the state of Texas, and I further agree that the substantive law of the state shall apply in that action without regard to the conflict of law ruses of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged upon entering BS or during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against BS on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
(Participates Information) Signature ______________________________________________________________ Date (mm/dd/yy) _______/_______/________ Print First Name_____________________________________________________ Print Last Name_________________________________________________ Street Address________________________________________________________________________________________________________ Apt.# _________ City _________________ State________ Zip___________ Phone (_____)__________-___________ Email______________________________________ Emergency Contact Phone (_____)__________-_____________ Emergency Contact Name_______________________________________________________ Date of Birth (mm/dd/yy) _______/_______/________ Age_________
PARENT’S OR GUARDIAN’S ADDITIONAL IDENTIFICATION-MUST BE COMPLETED FOR PARTICIPANTS UNDER THE AGE OF 18 BY PARENT OR GUARDIAN ONLY
I CONFIRM THAT I AM THE PARENT/LEGAL GUARDIAN OF THE PARTICIPANT ABOVE AND ANY FALSE CLAIMS OR MISREPRESENTATIONSTHAT I MAY HAVE MADE ON THIS DOCUMENT I TAKE FULL RESPONSIBILITY FOR AND WILL NOT HOLD BS LIABLE FOR ANY ACCIDENTS THAT MAY OCCUR WHILE ON THE PREMISES.
In consideration of __________________________________(Print minor’s name) (“Minor”) being permitted by BS to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless BS from any and all Claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
Paragraphs 1 through 6 above are incorporated herein by reference for all purposes. Said paragraphs are binding on me as parent or guardian of the above named minor or as signatory to this document. I accept the risks in the above paragraphs for myself and on behalf of the above named minor. I make and affirm the waivers, indemnities and releases in the above paragraphs for myself and on behalf of the above named minor. I make and affirm the certifications and representations in the above paragraphs for myself and on behalf of the above named minor.
Parent’s Or Guardian’s Signature _______________________________________________ Relationship to Minor _____________________________________ Date_____/_____/______ Print First Name_______________________________________________ Print Last Name_______________________________________________________ Driver’s License Number__________________________________ State_____________ BS Employee Initials__________
IF PARENT/GUARDIAN IS NOT PRESENT, FORM MUST BE NOTARIZED.
Notary Signature ______________________________________________ Date (mm/dd/yy) _______/_______/________ Notary Stamp: