Square State Skate/SVVSD Permission Form
Waiver/Participant Release of Liability
Square State Skate
SquareStateSkate.com
Info@squarestateskate.com
720-441-4047

ALL PARTICIPANTS MUST WEAR A HELMET
Waiver/Participant Release of Liability

Read Before Signing and Filing out the Google Form below

The risk of injury from the activities involved in skateboarding lessons, programs, or events, including the potential for permanent disability or death, and while particular rules, safety equipment, instruction and personal discipline may reduce the risk, the risk of serious injury to the participant does exist; and
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 the participation of my student.

I recognize the St. Vrain Valley Schools and Eagle Crest Elementary do not provide insurance coverage for student accidents. Low cost student accident insurance is available through www.kandkinsurance.com.

I, for myself and on behalf of my/our heirs, assignees, personal representatives, persons under my guardianship, and next of kin, hereby release St. Vrain Valley Schools, its employees, officers, and agents, Brian Ball, Square State Skate, and its instructors and contractors, with respect to any and all injury, disability, damage or death to person or property incident to my student’s involvement or participation in skateboarding lessons, programs or events, including transportation to lessons, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law.

I, for myself and on behalf of my/our heirs, assignees, personal representatives, persons under my guardianship, and next of kin, hereby indemnify and hold harmless all the above. Releases from any and all the liabilities incident to my student’s involvement or participation in skateboarding lessons, programs or events, even If arising from their negligence, to the fullest extent of the law.

I attest that my student is healthy enough to participate in this event safely, and acknowledge the responsibility for obtaining any medical opinions necessary to certify this fact.

I have read the 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 also waive and release the use of my photograph or likeness for any reason or purpose. Opting out requires signing the opt out line below. I wish for my student to participate in this hazardous sport and agree to assume full responsibility for all injuries and medical expenses incurred while participating in skateboarding lessons, programs, or events.

Parent/Guardian Initials (By initialing below, I agree to the terms and conditions expressed above) *
Your answer
Today's Date *
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Participant/Student Name *
Your answer
Classroom Teacher *
Participant/Student Date of Birth *
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Parent/Guardian First and Last Name *
Your answer
Parent/Guardian Telephone Number *
Your answer
Parent/Guardian Physical Address
Your answer
Parent/Guardian Email Address *
Your answer
Medical Release
Parent/Guardian Initials for Medical Release *
Your answer
Participant/Student Allergic to....?? Please type N/A if the answer is none *
Your answer
Doctor to be notified in case of emergency (Name and Medical Office Phone Number) *
Your answer
Please check this box if you do NOT want your student's image used in any social media/promotional materials
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