Hirschy Lab

Stay On The Grind


 

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.

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