Hirschy Lab Waiver
PLEASE READ: YOU ARE RESPONSIBLE FOR THIS INFORMATION~
I accept that snowboarding can be a hazardous activity which can result in serious personal injury or death. I understand that I assume all risks of personal injury or loss of damage to property. I recognize that the snowboard park at the residence of 15 S Old Creek Rd has variations in terrain and other obstacles and hazards including other participants which may exist throughout the area. I hereby release the property owners of 15 S Old Creek Rd and any and all agents from any and all legal liability and/or responsibility for any and all injuries or damages that may result in from my use of the property and facilities at the park.
I have carefully read this Agreement and Release of Liability and by signing below, I fully understand its contents and agree to its terms.
I hereby certify that I am over 18 years of age or I am the parent or legal guardian of the minor member listed below.
I have carefully read the foregoing and acknowledge that I understand and agree to all of the above terms and conditions.
I have had the opportunity to ask any and all questions regarding this agreement and the effect of the same.
I am aware that by signing this Agreement, I assume all risks and waive and release certain substantial rights that I may have or posses.
Snowboarder Name_______________________ Parent or Legal Guardian Name_________________________
Member Address_____________________________________ City___________________ Zip____________
Emergency Contact ________________________ Phone ________________ Relationship________________
Snowboarder Date of Birth (MM/DD/YY) ______________________Gender ___________
Snowboarder Signature______________________ Parent or Legal Guardian Signature____________________
On_________________, before me, __________________________________________ personally appeared
__________________________________, personally known to me___or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledge to me that he/she executed the same in his/her authorized capacity and that by his/her signature on the instrument, the person executed the instrument. WITNESS my hand and official seal.
[ SEAL ]
NOTARY PUBLIC IF PARENT OR LEGAL GUARDIAN OF MINOR DOES NOT APPEAR IN PERSON, THEN THIS SECTION MUST BE WITNESSED AND NOTARIZED BY A NOTARY PUBLIC.