Crystal Ice Figure Skating Club

HOLD HARMLESS

Indemnification/Waiver of Liability

Assumption of Risk Agreement


(Print Form)

 

In consideration of my participation in any Crystal Ice Figure Skating Club Inc. program, event, or activity, I acknowledge that I understand the nature of the activity and that I, and/or my minor child, am qualified, in good health, and in proper physical condition to participate in such activity.  I acknowledge that if conditions are unsafe, I and/or my minor child will immediately discontinue participation in the activity.

 

I fully understand that skating involves risks of serious bodily injury, including permanent disability, paralysis, and death, and the these and other risks may be caused by my own actions, or inaction, those of other participating in the event, the conditions in which the event takes place, or the negligence of the Releasees named below, and that there may be other risks either not known to me or not foreseen at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my, and/or my minor child’s participation in the activity.

 

I hereby authorize the Crystal Ice Figure Skating Club to arrange for emergency medical care for the minor identified herein in my/our absence and in doing so, I/we release Crystal Ice Figure Skating Club, Inc., and the releasees named below from any and all liability which it/they may have, including negligence for making such arrangements and decisions.

 

I hereby release, discharge and covenant not to sue the Crystal Ice Figure Skating Club, its officers, directors, members, agents, volunteers and employees, any sponsors and advertisers of any Crystal Ice Figure Skating Club sponsored event in which I participate (each considered one of the Releasees herein) from all liability, claims, demands, losses, or damages on my account caused and/or alleged to be caused in whole or in part by the negligence of the Releasees or by their actions or inactions.  I will indemnify, defend, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost which may incur as the result of such claim.

 

I acknowledge that I have read this release, indemnification, and waiver of liability and assumption of risk agreement and fully understand it.

 

 

1)

 

 

2)

 

Signature of participant

 

Signature(s) of Parent(s)/Natural/Legal Guardian(s)

Date signed_____________________

 

 

Date signed_____________________

 

 

 

 

Name of participant

 

Date of birth

Address

 

City                                          State               Zip

Telephone # (home)

 

Telephone # (work)

ISI #                                        USFSA #

 

Skill level

Medical

Insurance Company

 

Insurance ID #

Names of Parents(s)/ Natural / Legal Guardians:

1)

 

 

2)