Inline Skate Lesson Waiver Form
This is a Release

Waiver and Release from Liability

THE UNDERSIGNED, for himself, his personal representatives, heirs, next of kin, acknowledges, agrees, and represents that he has, or will immediately upon entering any area where the lesson is to take place and  continuously thereafter, inspect such area and all portions thereof which he enters and his participation in the event or lesson constitutes an acknowledgment that he has inspected such area and that he finds and accepts the same as being safe and reasonably suited for the purposes of his use, and he further agrees and warrants that if, at any time, he is in or about the area and feels anything to be unsafe, he will immediately advise the instructor of such and will leave the area.

THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the IISA/IASkate?USSG/ICP Certified Instructor: Stephen Fisher, the other participants, other instructors, owners and lessees of premises used to conduct the lesson, their officers and employees, from all liability to the undersigned, his personal representatives, heirs and next of kin for any and all damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence or otherwise while the undersigned is in or upon the said area, or participating in the lesson.

THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the instructor from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in or upon the said area or involved in the lesson.

THE UNDERSIGNED HEREBY FULLY ASSUMES RESPONSIBILITY FOR ANY RISK OR BODILY INJURY, DEATH OR PROPERTY DAMAGE caused by any reason including the negligence of the Instructor while participating in the lesson.

EACH OF THE UNDERSIGNED expressly acknowledges and agrees that the activities at the lesson and in the area are dangerous and involve the risk of serious injury and/or death and/or property damage. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducement apart from the forgoing written agreement have been made.

This waiver, release and indemnification agreement specifically embraces each and every lesson taken and to be taken by the student and applies to each and every activity herein above mentioned and has the same effect as if executed after each and every lesson or event in which the undersigned participates so that the parties herein intended to be released and indemnified shall be fully and effectively released and indemnified as to each and every lesson or event hereinabove described.

_______________________________________________________   Date: ________________

Sign: _________________________________ Email Address:__________________________        

Address (principal intersection): ____________________________________

Phone: W ____________H____________

Emergency Number:_______________________                Cell ________________________


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