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HomeMy WebLinkAboutSkate Park Use WaiverFEE SCHEDULE DIRECTIONS $3.00 per skater, per day $20.00 punch card for 10 skates Purchased at the Skate Facility or at City Hall in the Department of Finance. Skaters Name Street Address Emergency contact person (other than parent) Physician's Name 1121 Barber Street Sebastian, Florida (561) 581 -2630 Parents Name City From US 1: Take CR 512 westbound to Barber Street. Turn left on Barber Street. Skate Facility is approximately 3 /4 mile on the right. From I -95: Take Exit 69, CR512, Eastbound to Barber Street. Turn right on Barber Street. Skate Facility is approximately 3 /4 mile on the right Waiver A notarized or verified waiver must be completed prior to using the Barber Street Sports Complex Skate Facility, and must be submitted by the individual signing the waiver unless waiver is notarized. Completed waivers can be turned in at the Skate Facility, mailed or delivered to the City of Sebastian Department of Finance, 1225 Main Street, Sebastian, Florida 32958. Home Phone Number State Zip Emergency Phone Number Physician's Phone Number RELEASE, HOLD HARMLESS AND INDEMNIFICATION AGREEMENT CHOOSE ONE I, hereby certify that I am over the age of eighteen (18) years of age and am of sound mind and memory at the time of the execution of this Release. I /We, the parent(s) /legal guardian(s) of whose birth date is (hereinafter "minor), hereby certify that I am/We are over the age of eighteen (18) years of age, am /are of sound mind and memory at the time of the execution of this Release. A true and current photograph of the minor is attached hereto, and signed by me. WHEREAS, the City of Sebastian (hereinafter "CITY has made available a skate facility for skateboarding and rollerblading activities; and WHEREAS, the CITY agrees to allow me access to the skate facility to participate in skateboarding and rollerblading activities in consideration of my execution of this Release and agreeing to be bound by its terms. NOW, THEREFORE, IN CONSIDERATION of being allowed to participate in such activities, I /We herby agree as follows: 1. I /We are aware of and fully understand the inherent dangers involved in participating in skateboarding and rollerblading activities at skate facilities, including the risk of death and /or personal injury or damage to myself, or if applicable the minor, other persons and /or my or the minor's property or the property of others while participating in such activities or having my property, or if applicable, the minor's property, at the site of such activities. I /We further acknowledge that participants in such activities and other persons at the skate facility may not be covered under insurance of the CITY. I /We freely and voluntarily execute this Release with such knowledge, and assume full and sole responsibility for the risk of death, personal injury and /or property loss arising from or in any way connected with my, or if applicable the minor's participation in skateboarding and rollerblading activities at the skate facility. 2. I /We hereby release and forever discharge the CITY, its agents, employees or independent contractors and their respective sureties, insurers successors, assigns and legal representatives, from any liability, claim, cause of action, demand and damages for injury, death or damages of any kind or nature whatsoever to me, or if applicable the minor's, property as a result of my or the minor's participation in skateboarding and rollerblading activities whether such injury, death or property damage is caused by the intentional or negligent act or omission on the part of (i) any other participant in skateboarding or rollerblading activities at the skate facility, (ii) any employee, agent or independent contractor of the CITY, or (iii) any other person at the skate facility. Furthermore, I /We agree to pay any and all attorney's fees and costs of the CITY, and any of its agents, employees and independent contractors if I /We bring any action, claim or demand against the CITY or any of its agents, employees and independent contractors for any reason for which this Release applies. City of Sebastian Skate Facility When school is in session: Monday Friday 4pm -9pm Saturda 10am 10pm Sunday 12pm 9pm Summer Months Monday Saturday 10am 10pm Sunday 12pm 10pm The City of Sebastian Skate Facility is owned and operated by the City of Sebastian. The street course skating area is 7,700 sq. ft. For additional information please call: (561) 581-2630 City Hall (561) 589-5330 Only skateboards, in -line skates and quad skates, can be used at the facility. A signed, notarized or verified waiver must be on file. Proper identification is required. All skaters must wear a helmet, elbow and knee pads (shoes required for skateboarders). Obey posted skate facility rules and adhere to instructions provided by skate facility staff. Water is the only beverage permitted in skate area. While in the skate area, there shall be no smoking, profanity, glass containers or pets. Alcohol is not permitted on City park g rounds. No trespassing when facility is closed. Hours of Operation Requirements to Skate 3. I /We agree to indemnify and hold the CITY, its agents, employees and independent contractors, their sureties, insurers, successors, assigns and legal representatives harmless from any Liability, claim, cause of action, demand or damages for injury, death or damages of any kind or nature whatsoever to any person or their property as a result of my, or if applicable the minor's participation in the skateboarding and rollerblading activities. As a result of any actual or claimed intentional or wrongful act or omission by me, or if applicable the minor, arising from or as a result of my, or if applicable the minor's presence at the skate facility or my, or if applicable the minor's participation in skateboarding and rollerblading activities. Furthermore, I /We agree to pay attorney's fees and costs for any persons covered herein for any action arising under this Paragraph, whether or not such action is well founded. 4. I /We agree to and hereby bind my, or if applicable the minor's heirs, executors, assigns and all other legal representatives by executing this Release. 5. I /We hereby acknowledge and agree that this agreement is intended to be construed and interpreted as broad and inclusive as permitted by the laws of Florida. If any portion of this Release is found or declared to be invalid or unenforceable, such invalidity shall not affect the remainder of this Release not found to be invalid and the remainder of this Release shall remain in full force and effect. 6. BY EXECUTING THIS RELEASE, I /WE ACKNOWLEDGE THAT I /WE HAVE READ THIS RELEASE, UNDERSTAND THE CONTENTS HEREOF, HAVE BEEN ADVISED AND HAD THE OPPORTUNITY TO SEEK INDEPENDENT COUNSEL OF MY /OUR CHOICE AND CERTIFY THAT I /WE HAVE FREELY AND VOLUNTARILY EXECUTED THIS RELEASE, AND THAT ALL REPRESENTATION I HAVE MADE ARE TRUE. I FURTHER ACKNOWLEDGE THAT, BUT FOR THE EXECUTION OF THIS AGREEMENT AND AGREEING TO BE BOUND BY THE TERMS HEREOF, THE CITY WOULD NOT AUTHORIZE ME, OR IF APPLICABLE THE MINOR, TO GAIN ACCESS TO THE SKATE FACILITY AND PARTICIPATE IN THE SKATEBOARDING AND ROLLERBLADING ACTIVITIES OF THAT FACILITY. 7. I/We agree to abide by all regulations that the CITY may impose regarding the operation and utilization of the skate facility 8. UNDER PENALITIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AGREEMENT AND THE FACTS STATED IN IT ARE TRUE. EXECUTED this day of Signature of Skater (if over the age of 18) Signature of Parent Signature of Legal Guardian IF PARENT /LEGAL GUARDIAN DOES NOT SUBMIT WAIVER IN PERSON, THIS FORM MUST BE NOTARIZED. STATE OF FLORIDA COUNTYOF I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgements, personally appeared who is /are personally known to me, or who furnished the following forms of identification: Who executed the foregoing instrument, and (s) he acknowledged before me that (s) he executed the same. WITNESS my hand and official seal in the County and State last aforesaid this day of Notary Public: Seal: