Please take a moment to fill out our liability waiver, please and thank you!

Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

####

Email

Skate Camper's Name

First Name

Last Name

Rentals Needed

We have a limited number of rentals that can be rented for free as supplies last!

Helmet

Skateboard

N/A

I, the undersigned, on behalf of myself (as parent, guardian, coach, aid, spectator, or participant) hereby: 1. Acknowledge that I have read this document, I voluntarily sign this document. 2. Release Varsity Skateboarding Organization, its directors, ofﬁcers, employees, agents, representatives and volunteers (collectively "releases") from all liability to me for any loss or damages to property or injury or death to person, whether caused by Releases or otherwise and while such minor is in attendance of Varsity Skate Academy or any other program activity under Varsity Skateboarding Organization. 3. I agree not to sue Releases for any loss, damage, injury, or death described above and I will indemnify and hold harmless releases and each of them from any loss, liability or damage or cost they may incur due to said minor’s presence in attendance of Varsity Skate Academy, whether caused by the negligence of Releases or otherwise. 4. I assume full responsibility for, and risk of, bodily injury, death or property damage due to the negligence of releases or otherwise. 5. I do hereby authorize Varsity Skateboarding Organization as agent for the undersigned, to consent with respect to said minor, to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by and is to be rendered under general or special supervision of, any physician and surgeon licensed under the provisions of the Kansas and Missouri Medical Practice Act on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the ofﬁce of the physical or the hospital, I understand that Varsity Skateboarding Organization and is not responsible for any costs incurred for medical care. 6. I hereby grant and authorize Varsity Skateboarding Organization the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures and/or video taken of my child by Varsity Skateboarding Organization Leaders to be used in and/or for legally promotional materials including, but not limited to, newsletters, ﬂyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites, and other print and digital communication, without payment or any other consideration. I intend this document to be as broad and inclusive as permitted by the laws of the State of Kansas and Missouri. I HAVE READ AND UNDERSTOOD THIS AGREEMENT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES.

Today's Date

MM

DD

YYYY

FREE Skate Camp Liability Waiver

wednesday, august 27th
6PM - 7PM

JOIN US FOR A FREE SKATE CAMP AT the summit church:
3381 NW Chipman Rd, Lee's Summit, MO 64081

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FREE Skate Camp Liability Waiver

wednesday, august 27th6PM - 7PM

JOIN US FOR A FREE SKATE CAMP AT the summit church: 3381 NW Chipman Rd, Lee's Summit, MO 64081

wednesday, august 27th
6PM - 7PM

JOIN US FOR A FREE SKATE CAMP AT the summit church:
3381 NW Chipman Rd, Lee's Summit, MO 64081