SUPA Society Presents ASD Autism SK8 Day sponsored by PAFN
SKATEBOARDING WAIVER AND RELEASE FORM
PARTICIPANT RELEASE OF LIABILITY – READ BEFORE SIGNING
In consideration for being allowed to participate in any way in the skateboarding events and
related activities (the “Events”) taking place at the Pacific Autism Family Network Centre located
at 3688 Cessna Drive Richmond, BC (the “Venue”), the undersigned acknowledges, appreciates,
and voluntarily agrees that:
1. Assumption of Risk. The risk of injury from the Events involved is significant, including the
potential for permanent disability and loss, and while particular rules, equipment, and personal
discipline may reduce this risk, the risk of serious injury to me does exist. I knowingly and freely
assume all risks, both known and unknown, even if arising from the negligence of the Releases
(defined below), and assume full responsibility for my participation in the Events and
attendance at the Venue. I willingly agree to comply with all rules, guidelines, policies, terms
and conditions for participation established by SUPA Society in connection with the Event or
Venue or otherwise.
2. Release and Waiver. I (and if younger than 19 years old, my parent or legal guardian on my
behalf), for myself and on behalf of my heirs, assigns, personal representatives and next of kin
(the “Releasors”), hereby release, waive, indemnify, and hold harmless SUPA Society and each
of their respective agents, employees, officers, directors, trustees, and all other persons or
entities acting on their behalf, and each of their successors and assigns (the “Releasees”), from
any and all liabilities, claims, causes of action, losses or expenses which the Releasor may have
by reason of any matter directly or indirectly relating to my presence at the Venue or
participation in the Events, including, but not limited to, claims for any and all injuries, disability,
death, loss or damage to person or property, whether arising from the fault, negligence, breach
of contract or any duty of care, of the Releases or otherwise, to the fullest extent permitted by
law, including attorney’s fees and attorney’s fees on appeal. Without limiting the foregoing, I
(and if younger than 19 years old, my parent or legal guardian on my behalf), on behalf of
Releasors, covenant and agree to waive any and all claims and not to institute legal proceedings
against any Releasees for any of the liabilities that have been released and discharged herein.
3. No Obligation of Releasees. None of Releasees shall have, or be deemed to have, any
obligation to the Releasors hereunder or otherwise in connection with any Events unless set
forth in writing signed by Releasor and Releasee. I (and if younger than 19 years old, my parent
or legal guardian on my behalf), understand that the Releasees do not carry or maintain health,
medical, or disability insurance coverage for Releasor. I (and if younger than 19 years old, my
parent or legal guardian on my behalf), further acknowledges that the Releasees cannot
guarantee the my safety in connection with the Events and that the Releasees make no
representations, warranties or guarantees about my safety.
4. Right of Publicity. I (and if younger than 19 years old, my parent or legal guardian on my
behalf), hereby grants to Releasees and each of their designees the unrestricted, royalty-free,
irrevocable,
non-exclusive, paid-up right and license to (a) take photographs and make audiovisual
recordings of Releasor in connection with my participation at or in any of the Events
(“Materials”) and (b) reproduce, copy, publish, display, distribute, adapt, publicly present,
communicate to the public by telecommunications, copyright, license, modify, edit, create
digitized images of, broadcast, reuse, derivative works of and otherwise exploit or use and
permit to be used such Materials or any part thereof, whether alone or in combination with
other materials, in any and all markets and media now known or hereafter devised in
perpetuity. In connection with the foregoing, I (and if younger than 19 years old, my parent or
legal guardian on my behalf), hereby irrevocably consents and authorizes Releasees to use or
authorize the use of my name, image/likeness, photograph (still and moving), picture, voice
recording, performance, and/or any other identification for any and all purposes, including,
without limitation, advertising, publicity, instructional, sales relating thereto or any other
purposes in connection with the Events, in any and all media now known or hereafter devised in
perpetuity, without compensation, notice or right of prior review or approval (to the extent
permitted by law). I (and if younger than 19 years old, my parent or legal guardian on my behalf)
agree, to release and discharge each Releasee from, and not to institute legal proceedings
against any Releasee for, any and all liabilities relating to any claim for invasion of privacy,
violation of right of publicity, defamation or appropriation, or any similar claim I or any Releasor
may have now or in the future, whether known or unknown, in connection with any such use.
Except to the extent expressly permitted by law, I (and if younger than 19 years old, my parent
or legal guardian on my behalf), undertake and agree not to withdraw consent to the collection,
use and disclosure of Materials
5. Miscellaneous. The Release shall be governed by and construed in accordance with the laws
of the Province of British Columbia. If any portion of the Release shall be held invalid or
unenforceable, the remaining portion hereof shall not be affected thereby and shall remain in
full force and effect.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I, OR MY HEIRS, NEXT OF KIN, EXECUTORS,
ASSIGNS AND REPRESENTATIVES, HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND
SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I am aware that the usual
risks, hazards, and dangers of personal injury, death, and disability increase when using ramps,
curbs, steps, half-pipes, inclines, or declines, bowls, or any other structure or device. I also
understand that these risks, hazards, and dangers are further increased when other persons,
whether or the same level of experience or skill, are using the same facilities. I attest that I am
physically fit and I am prepared for this activity. I also waive and release the use of my
photograph and likeness for any reason or purpose. I WANT TO PARTICIPATE IN THIS
HAZARDOUS SPORT!
MEDICAL RELEASE (FOR 19 YEARS AND OLDER): In the event that I am unconscious or
otherwise unable to make medical decisions for myself in an emergency, I hereby give
permission for medical treatment and related transportation, to any licensed physician,
surgeon, clinic, hospital, or ambulance service to secure proper treatment.
ASD Autism SK8 Day INFO SHEET
Date of Birth__________________________________________________________________________
Name________________________________________________________________________________
Address______________________________________________________________________________
Phone_______________________________________________________________________________
Emergency Contact_____________________________________________________________________
Family Physician and Contact (if applicable)__________________________________________________
PARTICIPANT SIGNATURE (I hereby represent and warrant that I am over the age of 19)
_________________________________________________
Date Signed_______________________________________
PARENT OR LEGAL GUARDIAN
I am a parent (or legal guardian or the person having parental authority) of the minor who has
signed this release and consent and I hereby agree that I and the said minor will be bound by all
the provisions contained herein. I represent and warrant that I have legal custody of said minor
and I hereby agree to indemnify and hold the Releasees harmless from and against any
Liabilities arising out of or in connection with any settlement, order or judgment in favour of the
minor.
NAME OF PARENT (OR LEGAL GUARDIAN OR PERSONAL HAVING PARENTAL AUTHORITY):
______________________________________________ (Please Print)
SIGNATURE: ____________________________ DATE: ________________________________