New Skater waiver 2022
Lothian Roller Derby
New Skaters Liability Waiver, Release & Emergency Contact

Sign in to Google to save your progress. Learn more
Email *
Personal Information  (I understand that my name and address shall be maintained on a register of current members, available to selected league members.)    Name: *
Address: *
Date of birth *
MM
/
DD
/
YYYY
Telephone number *
Email address *
Please give details of any relevant medical information (we advise you to make coaches aware on the day in addition to providing the information here) *
Emergency contact name and number *
Shoe size *
I am fully aware that roller skating carries risk, including physical injury ranging from minor injuries, major injuries and in extreme cases death. It may also cause damage to my personal property. • To the best of my knowledge, I am in good physical condition and fully able to participate in roller skating and roller derby. • I understand that I will not be allowed to participate in the full contact aspects of roller derby until I am safe to do so and have met the minimum standards of skating skill. • I volunteer to participate in the associated activity surrounding roller derby and assume all responsibility for any risk, loss or damage or personal injury that may occur to me or my property including loss of earnings. • I agree that to the extent permissible by law, Lothian Roller Derby (including all league members and event volunteers) have no liability to me whatsoever for any direct or indirect loss, (including, but not limited to injury or death) sustained by me during or in any way related to my participation in the Event• I agree to follow government guidelines concerning the COVID-19 pandemic and that I might be asked to wear a mask when in close proximity with others.• I have read, understand and agree to the points noted above and sign the agreement of my own free will. *
Permission is hereby granted to Lothian Roller Derby to use quotations, photographs, films, video, and/or voice recordings made during the activity(ies) of any participants for publicity purposes, including but not limited to, community awareness, educational efforts, and other related initiatives.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy