In consideration of being allowed to participate or allowing my child to participate in any way in the program, parks, related events, activities, and all other non-sanctioned and/or 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/my child 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/my child’s 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 /my child’s readiness for participation and/or in the program/park/facility/event itself, I will remove myself/my child 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 INDEMNIFY AND HOLD HARMLESS Divers Unlimited & Mike’Sk8 Park and its’ members, officers, officials, agents, and/or employees, other participants, non sanctioned and sanctioned events,  parks, organizations, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct/operate the event/facility (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property incident to my/my child’s involvement or participation in the facility/event/programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by 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 and/or my child is physically and mentally capable of taking part in this activity. I also waive and release the use of my and/or my child’s photograph or likeness for any reason or purpose for marketing/promotion of events/activities/business of this facility.   I WANT myself/my child TO PARTICIPATE IN THIS HAZARDOUS SPORT and agree to have myself/my child wear the safety helmet with chinstrap securely fastened at all times!

I AGREE TO ASSUME FULL RESPONSIBILTY FOR ALL INJURIES AND MEDICAL EXPENSES INCURRED WHILE PARTICIPATING IN THIS FACILITY, EVENT, SKATEBOARDING,  RIDING, OR PLAYING IN AND AROUND THIS EVENT OR PROGRAM or FACILITY.

Blanket Waiver / Release of Liability  Page 2 of 2 

(Divers Unlimited of Norfolk, Inc. Trading As Mike’Sk8 Park)

Emergency Contact Information:

For (Participant) ___________________________________ 

Alternate contact phone numbers: _____________________________________________________________________

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

Parents - please note - your children are your responsibility.  It is your responsibility to be on time to pick them up when the park closes. And it is your responsibility to instruct them as to whether or not they are allowed to leave the park for any reason.  While we make every effort to ensure the safety of everyone in our facility, we cannot be responsible for tracking your child if you choose to leave them unattended.

SIGNATURE MUST BE NOTARIZED UNLESS WITNESSED BY OFFICIAL: EVENT STAFF, PASTORS, TEACHERS, SWORN POLICE OFFICERS OR PARTICIPATING EVENT VOLUNTEER or FACILITY EMPLOYEE.

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