Child Waiver - Retro Rollers

Child's/Minor's Waiver

Please read and complete all sections

            1
          
              Venue
              
              Date/Location
              
            2
          
              ADULT Details
              
              Details of ADULT
              
            3
          
              CHILD  Skater Details
              
              Details of CHILD Skater
              
            4
          
              Emergency Contact Details
              
              Details in case of emergency
              
            5
          
              Waiver
              
              Agreement

What name has the booking been made under? *

Please select the VENUE you are attending *

Please select the date of the EVENT you are attending *

ADULT Details

Adult's First Name *

Adult's Last Name *

Adult's Date of Birth *

Adult's Phone Number *

Adult's First line of address *

Adult's Town *

Adult's Postcode *

Adult's Email *

CHILD Skater Details

Child's First Name *

Child's Last Name *

Child's Date of Birth *

Child's First line of address *

Child's Postcode *

What is your relationship to the child? *

Does the child have any known medical conditions? *

I confirm that I am the child’s parent or legal guardian *

I Confirm

Emergency Contact Details

This will be someone who is not attending with yourself or child/ren that can be contacted in case of emergency

First Name of Emergency Contact *

Last Name of Emergency Contact *

Phone Number of Emergency Contact *

What is the Emergency Contacts relationship to you? *

Waiver *

RETRO ROLLERS shall be referred to hereafter as "the Provider"; In consideration of being allowed to participate in any way in skating, related events and activities, or any other service or event associated with the Provider the undersigned acknowledges, appreciates, and agrees that:
1. The risk of injury from roller skating is possible including the potential for permanent paralysis and death. While particular rules, equipment, tuition and personal discipline may highly reduce risk, the risk of serious injury does exist. I acknowledge and accept that my participation in the activities provided entails known and unknown risks that may result in such in injuries or death.
2. I have of my own desire and free will to undertake and to use the services and/or equipment of ‘The Provider’. I agree to FULLY INDEMNIFY AND HOLD HARMLESS ‘the provider’, its servants and agents from all claims, demands, actions and suits which at any time hereafter be brought by any person, for personal injury, death or property damage suffered by services and/or equipment.
3. I agree to inspect the facilities and equipment to be used and if I believe anything to be unsafe I will immediately advise the ‘the provider’ of such conditions and refuse to participate.
4. I acknowledge that under no circumstances will anyone under the influence of alcohol and or drugs be allowed to enter any of premises or partake in any activity provided by ‘the provider’.
5. I acknowledge that if I have any pre-existing medical conditions I have sought medical advice prior to skating. I confirm that I am not pregnant, nor have any known physical injuries/ailments that may affect me, or may be exacerbated by participating in such activities.
6. I agree that I will only carry out moves and tricks that are within my skill level and of which I am able to retain control of at all times. I understand that I skate, dance and play games at my own risk. I agree to adhere to all safety instructions and recommendations whether oral or written.
7. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation.
8. I, for myself, and on behalf of my heirs, assigned, personal representatives and next of kin hereby release and hold harmless ‘the provider’, their officers, officials, agents and/or employees, volunteers, other participants, and, if applicable, owners and lessors of the premises used to conduct the event or day to day business, with the respect to any and all injury, disability, death, or loss or damage to person or property. Whether arising from the negligence of the releases or otherwise.
9. I agree to adhere to ‘the provider’s’ CODE OF CONDUCT and behave in an orderly manner towards ‘the provider’, including their officers, employees, volunteers, Leisure Centre staff as well as other skaters. Failure to do so may result in exclusion from the skating session, without refund, and potential further ban.
10. In the event of illness or accident, I give my permission for medical treatment to be administered where considered necessary by a nominated first-aider, or by suitably qualified medical practitioners.
11. Any ticket that has been purchased on behalf of others, their acceptance and them taking part in the events/activities constitutes their agreement to these terms and waiver.
12. I agree to check and maintain my equipment and ensure they are fit for purpose – including skates and protective equipment such as knee pads, elbow pads, wrist guards and helmets.
13. I grant full permission to the Provider to use photography/video and other recorded social media of myself and any children within my care, for publicity, advertising, and/or marketing purposes and waive any ownership of or rights to said media.
14. I understand that my ticket is non refundable and I may not sell my ticket or give it to someone else. I understand the tickets and waivers completed apply only to the names attached to them and therefore cannot be transferred.
15. All children under the age of 18 must be accompanied by a responsible adult. All under 18’s must also wear full protective gear consisting of helmet, knee pads, elbow pads and wrist guards at all times whilst participating in these activities.
16. No responsibility will be taken by the provider for loss or damage to personal belongings/property

I have carefully read this entire agreement and all details in this form are complete and correct.

I acknowledge the contents of this form and agree to be bound by its terms. I understand that any and all risks, whether known or unknown, are expressly waived in advance. *

Yes - I have read, understood and agree.

I confirm that I have legal responsibilty to complete and sign this form on behalf of the child/minor *

I confirm

I understand that the child must be supervised and must NOT be left alone at this event *

I confirm

Signature *

Child's/Minor's Waiver

ADULT Details

CHILD Skater Details

Emergency Contact Details

This will be someone who is not attending with yourself or child/ren that can be contacted in case of emergency

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