Waiver Form

PARTICIPANT AGREEMENT, AGREEMENT TO INDEMNIFY, & RISK ACKNOWLEDGMENT

In consideration of the services of The Village of Greenport / Department of Parks & Recreation, their agents, officers, participants, consultants, employees, and all persons of entities acting in any capacity on their behalf (herein after collectively referred to as PARKS), I now agree to release & discharge PARKS, on behalf of myself, me children, my parents, my heirs, assigns, personal representatives and estate as follows:

1. I acknowledge that in-line skating, skateboarding, and biking entail known & unanticipated risks, which could result in physical or emotional injury, paralysis, death or damage to myself, to property or to third parties. I understand that such risks cannot be eliminated without jeopardizing the essential qualities of the activity. In an effort to minimize those risks I agree to wear a protective helmet at all times in the Skate Park.

THE RISKS INCLUDE, BUT ARE NOT LIMITED TO:

(1) Nature of the activity.

(2) Latent or apparent defects or conditions in equipment or property supplied by PARKS, or other persons or entity.

(3) Use of property by myself, others or equipment supplied by PARKS, or other persons or entity.

(4) Acts of other participants in this activity, employees or agents of PARKS.

(5) My own physical condition, or own acts or omissions.

(6) Conditions of PARKS' facility & surrounding grounds or terrain and accidents connected with their use.

(7) First aid emergency treatment of other services.

2. I expressly agree and promise to accept and assume all the risks existing in this activity. My participation in this activity is purely voluntary and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless PARKS from any and all claims, demands or causes of action which are in any way connected with my participation in this activity or my use of PARKS equipment of facilities, including any such claims which allege negligent acts or omissions of PARKS.

4. Should PARKS or anyone acting on their behalf be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless of all such fees and costs.

5. I hereby certify that I have adequate insurance to cover any injury or damages I may cause of suffer while participating or else I agree to bear the costs of such injury of damage myself. I further certify that I have no medical or physical conditions, which could interfere with my safety in this activity, or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition.

6. I understand that Greenport Skate Park Staff members have full control over the park and I will obey any rules posted or verbally stated to me at any time. I understand that the designated area for "beginners" is only for beginners and if I make the choice to enter the designated area without permission by one of the staff members I understand that I can be revoked the use of the park at any time without the refund of my admission fee. And I also understand the Greenport Skate Park Coordinator has the right to revoke my usage of the park for any length of time for any reason he deems necessary. If I decide to enter the park before the length of time is up I understand proper authorities will be called and charges can be pressed.

By signing this document, I acknowledge that if anyone is hurt, or property is damaged during my participation in this activity, a court of law may find me to have waived my right to maintain a lawsuit against PARKS. On the basis of any claim from which I have released them herein.

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THE ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT. AND I AGREE TO BE BOUND BY ITS TERMS.

Print Name: ___________________________ Signature of Participant: ___________________

Street Address: _________________________ PO Box: __________________ City: __________________________ State: __________________ Zip: _____. Phone number: _____________________

Emergency Phone and contact name: _______________________________ Date: __________________

PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION

(GUARDIANS OF PARTICIPANTS, UNDER THE AGE OF 18, MUST COMPLETE THIS SECTION)

In consideration of __________________________________________ (print minor's name) ("Minor") being permitted by PARKS to participate in its activities and use its equipment and facilities, I further agree to indemnify and hold harmless PARKS from any and all claims which are brought by or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

By signing this document, I acknowledge that if anyone is hurt, or property is damaged during the Minor's participation in this activity, a court of law may find me to have waived my right to maintain lawsuit against PARKS, on the basis of any claim from which I have released them herein.

I HAVE HAD SUFFICIENT OPPORTUITY TO READ THE ENTIRE PARTICIPANT AGREEMENT, AGREEMENT TO INDEMNIFY, & RISK ACKNOWLEDGEMENT DOCUMENT ON THE FRONT OF THIS SHEET. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.

Signature of Parent or Guardian:___________________________________________________

Print Name: _______________________________________________________

Emergency Phone or Beeper number: ______________________________________________

Date: ________________________________