BREVARD COUNTY TRAVELING SKATE PARK
Skate Registration Form for Skateboard & Inline Skate Activities

  • Skaters must wear helmets to skate. Knee pads, elbow pads, and wristguards are strongly recommended.
  • Skaters 17 and under MUST have this registration form signed by a PARENT to skate.
  • Skaters 18 and older must have a photo ID and sign this form to skate.
  • Information: Call 321-455-1380 or email skatepark@brevardparks.com
SECTION A
Participant Name: Home Phone:
Street Address:
City, State: ZIP:
Age: Sex: Date of Birth: Grade: School:
Emergency Contact: Phone:
MEDIA RELEASE

_____ I hereby give my permission for release of photographs taken of myself or my child while participating in this event.

_____ I do NOT give permission to release photographs of myself or my child.

SECTION B

EMERGENCY MEDICAL RELEASE — All participants ages 17 and under must have Parent/Guardian fill out this section

  1. If emergency medical care is deemed necessary and I or any other parent/guardian on list above cannot be contacted, I grant permission for my child to receive emergency medical treatment by the proper authorities.
  2. Having been informed of the activity to provide the above supervised activities I, the parent or legal guardian, of the participant named above, do hereby give my approval of his/her participation in these activities. I assume all risks and hazards incidental to the conduct of this activity; and, I do further hereby release, absolve, indemnify and hold harmless the organizers, sponsors and persons involved in running this tournament, any and all of them. In case of injury to my or son/daughter, I hereby waive all claims against the organizers, the sponsors, or any of the supervisors appointed by them.
Parent/Guardian Signature: Insurance Carrier:
Print Name: Date:
SKATERS & PARENTS   MUST FILL OUT & SIGN PAGE 1 & 2 OF FORM

Pursuant to chapter 119, Florida’s Public Records Act, this record is a public document that may be inspected and copied. If you believe any portion of this document contains information that is exempt from disclosure, please notify in writing:  Central Area Parks Operations, 840 Forrest Ave, Cocoa, FL 32922

INFORMATION: 321-455-1380

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Traveling Skate Park | Brevard County Parks and Recreation

PARTICIPANT AGREEMENT, RELEASE, AND ACKNOWLEDGEMENT OF RISK FOR BREVARD COUNTY TRAVELING SKATE PARK SKATEBOARD, INLINE SKATE, & SCOOTER ACTIVITIES

In consideration of the services of Brevard County Parks and Recreation Department, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf hereinafter collectively referred to as "BCP&R"), I hereby agree to release, indemnify, and discharge BCP&R, on behalf of myself, my children, my parents, my heirs, assigns, personal representative & estate as follows:

  1. I acknowledge that skateboarding and inline skating entails known and 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 simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things:  Collision with other boarders or inline skaters, the walls or other fixed objects; falling down; my Own equipment failure or the failure of other's equipment; my own or others negligence; and objects or conditions on the boarding surface that may cause me to fall; broken bones, sprains, head and back injuries, abrasions, and bruises.Furthermore, BCP&R employees have difficult jobs to perform.  They seek safety, but they are not  infallible.  They might be  unaware of a participant's fitness or abilities. They may give inadequate warnings or instructions, and the equipment being used might malfunction.
  2. I expressly agree and promise to accept and assume all of 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 BCP&R 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 BCP&R's equipment or facilities, including any such Claims which allege negligent acts or omissions of BCP&R.
  4. Should BCP&R or anyone acting on their behalf, be required to incur attorney's fees & costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees & costs.
  5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or 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. In the event that I file a lawsuit against BCP&R, I agree to do so solely in the state of Florida, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state.
  • I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
  • By signing this document, I acknowledge that if anyone is hurt or property is damaged during my  participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against BCP&R on the basis of any claim from which I have released them herein.
  • I have had sufficient opportunity to read this entire document.  I have read and understood it, and I agree to be bound by its terms.
SECTION C — SKATERS 18 OR OLDER MUST COMPLETE THIS SECTION
Signature of Participant: Date:
Print Name: Phone:
SECTION D — PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION
Must be completed for participants under the age of 18

In consideration of ________________________________(print minor's name) ("Minor") being permitted by BCP&R to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless BCP&R 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.
Parent or Guardian Signature: Relationship to Minor:
Print Name: Date:

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Traveling Skate Park | Brevard County Parks and Recreation