AntiGravity Waiver / Release of Liability

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ORGANIZATION, EVENT OR PARK

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DATE

In consideration of being allowed to participate in any way in the program, parks, related events, activities, and all other sanctioned parks and events the undersigned acknowledges, appreciates, and agrees that:
1. The risk of injury from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury to me does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If I observe any unusual significant concern in my readiness for participation and/or in the program itself, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
4. I, for myself and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE ANTIGRAVITY MX/SKATE/BMX and its’ members, officers, officials, agents, and/or employees, other participants, sanctioned events, sanctioned parks, sanctioned organizations, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property incident to my involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
5. I, for myself and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent of the law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I attest that I am physically and mentally capable of taking part in this activity. I also waive and release the use of my photograph or likeness for any reason or purpose. I WANT TO PARTICIPATE IN THIS HAZARDOUS SPORT and agree to wear my safety helmet and chinstrap securely fastened at all times! No sandals or Crocs.

I AGREE TO ASSUME FULL RESPONSIBILTY FOR ALL INJURIES AND MEDICAL EXPENSES INCURRED WHILE RIDING IN THIS PARK, EVENT OR PROGRAM.

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PARTICIPANT NAME (Please Print)

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PARTICIPANT SIGNATURE

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ADDRESS

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DATE OF BIRTH

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CITY                                                                                 STATE

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PHONE NUMBER

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ZIP CODE

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EMAIL ADDRESS

Emergency Contact Information:

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EMERGENCY CONTACT NAME

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EMERGENCY CONTACT PHONE NUMBER

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DOCTOR TO BE NOTIFIED IN CASE OF AN EMERGENCY

If participant is a minor (under 18 years of age):

MEDICAL RELEASE: In the event that I cannot be reached in an emergency, I hereby give permission to any licensed physician, surgeon, clinic, or hospital to secure proper treatment, and to order anesthesia, for my child/myself as named above. My child/I am allergic to the following medications:

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PARENT/GUARDIAN NAME (Please Print)

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PARENT/GUARDIAN SIGNATURE

SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY OFFICIAL: EVENT STAFF, PASTORS, TEACHERS, TOWN OFFICIALS, SWORN POLICE OFFICERS OR AN ANTIGRAVITY BOARD MEMBER.

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WITNESS SIGNATURE