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Adult Waiver Form - Skateboarding, Bmx Biking Or Inline Skating - Dekalb County Parks And Recreation Department

18 Years of Age and Over

DEKALB COUNTY PARKS AND RECREATION DEPARTMENT

ADULT WAIVER FORM

SKATEBOARDING, BMX BIKING OR INLINE SKATING

(This form must be signed in the presence of staff)

PLEASE PRINT

LAST NAME ____________________ FIRST NAME ________________Date of Birth___________

Address ___________________________________________________________________________

City ____________________________________ State ____________ Zip Code ________________

Phone (

) ____________________________ E-mail __________________________________

Emergency Contact ________________________________ Phone (

) ____________________

Medical Alert _______________________________________________________________________

I, ________________________________________, the undersigned being 18 years of age or older, seek to

participate in skateboarding or inline skating or BMX biking at DeKalb County’s Brook Run Skate park.

Therefore, I, acknowledge, agree and understand that:

1. The undersigned recognizes the risks and dangers inherent in skateboarding, BMX biking and inline

skating; I have examined the Skate Park arena personally; and represent that I am capable of using this

arena for the purpose for which it was intended, that is, as a venue for skateboarding, BMX biking and

inline skating.

2. The undersigned, by signing this form, releases DeKalb County, its officers and employees, from any

liability as to any injury which may be suffered by the undersigned while using the Skate Park, and

assumes all risk in connection with the use of the Skate Park. The undersigned indemnifies and holds

harmless DeKalb County from liability for any injuries the undersigned may suffer or may cause to

another participant.

3. I agree to be bound by and to follow all rules and regulations of the DeKalb County Parks and

Recreation Department pertaining to the Brook Run Skate Park, as stated below. It is understood that

violation of these rules may result in the suspension or termination of the privilege to use the Brook Run

Skate Park.

Adult Waiver Form

07/05/07

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Adult Waiver Form - Skateboarding, Bmx Biking Or Inline Skating - Dekalb County Parks And Recreation Department