A People ・ A Church ・ A School ・ A Future -- 1500 Wauwatosa Avenue, Wauwatosa, WI 53213 | Phone: 414-258-4320
Location: St Pius X Gymnasium - 2506 Wauwatosa Ave, Wauwatosa, WI 53213
Activity: Roller Skating
Date(s): This waiver applies to all skates nights during 2017/18 school year if initialed below.
I agree that I (or my child/ward if Participant is a minor) am/is voluntarily participating in the above named activity. I realize that there are numerous risks associated with my participation in this event; including (but are not limited to): injuries caused by falls or contact with other participants, sprains, contusions, broken bones,lacerations, concussions, permanent disability, internal injuries, paralysis and possibly death. These risks could impair my future ability to earn a living, engage in business, social and recreational activities and to generally enjoy life.
I (for my minor child/ward) agree to accept all of the previously mentioned risks and certify that I am in suitable, good physical condition to actively participate in the Activity described above. I agree to dress appropriately and understand that the Skate facility does not rent/provide helmets or other safety equipment to skaters. The use of helmets and other safety gear is encouraged by the parish and the school, but use of personal safety equipment cannot eliminate the risk of injuries associated with the event. I agree to stop if I (my minor child/ward) is in pain or has other indicators that suggest it would be unwise to continue participation. I certify that I have adequate health and/or disability insurance that will respond to any illness or injury that may occur during the aforementioned Activity.
I agree to protect, defend, hold harmless and fully indemnify St Pius X Parish and Wauwatosa Catholic School, as well as the Skate Night employees, volunteers and their representatives for any claim or cause of action whatsoever arising out of the above mentioned Activity, which takes place during the above identified dates, that is brought against the Parish or the Skate Night employees, volunteers and representatives by me, or my family members, whether such claim arises from the alleged negligence of the Parish or School, the negligence of its employees, volunteers, representatives, by the negligence of any other Activity participant (known or unknown) or by my own negligence.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OR RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I INTEND MY TYPED SIGNATURE IN THE BOX BELOW TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTEND ALLOWED BY LAW.
Your time to complete the form is about to expire due to inactivity. Please click "Continue Working" to complete the form and submit, otherwise your changes will be lost.
Your session will expire in 60 seconds.
Your time to complete the form has expired due to inactivity. Please click the button below or refresh the page with your browser and try again.