AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY

Skater’s Name: _________________________________________

(Please Print)

In consideration of being allowed to participate in the Tri-County Ice Arena/Appleton Family Ice Center/Valley Figure Skating Club program, related events and activities, including, but not limited to programs at the Arena and Off-site, the undersigned acknowledges, appreciates and agrees that:

1. The risk of injury from the activities involved in this program is significant, including, but not limited to, the potential for permanent paralysis and death and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown and assume full responsibility for my participation; and

3. I willingly comply with the stated and customary terms and conditions for participation. If, however, I observe, or in the case of a minor, the parent(s) or legal guardians(s) observe, any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and

4. I, for myself, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, WAIVE AND HOLD HARMLESS, TRI-COUNTY RECREATION ASSOCIATION, TRI-COUNTY ICE ARENA, APPLETON FAMILY ICE CENTER, THE TOWN OF MENASHA, WINNEBAGO COUNTY, OUTAGAMIE COUNTY AND THE VALLEY FIGURE SKATING CLUB, their representative administrators, members, directors, agents, coaches, officials, other participants, sponsors, advertisers, and, if applicable, owners and lessors of the premises used to conduct the event, including, but not limited to, at the Arena, in transit to or from the Arena, hereinafter referred to as “releases”, from any and all liability to each of the undersigned, and any and all claims, demands, losses or damages on account of INJURY, DISABILITY, OR DEATH, or loss or damage to property.

5. I also understand and accept the fact that by the terms of the ice rental contract between Tri-County Recreation Association, Appleton Family Ice Center and the Valley Figure Skating Club, the Tri-County Recreations Association, Inc., the Tri-County Arena, the Town of Menasha, Winnebago County, Outagamie County, and the officers, directors, supervisors and employees of the above entities are not responsible for any property damage or loss suffered by me which occurs in the locker rooms or any other area wherein property of mine or the skating club is kept or stored, either permanently or temporarily.

6. This waiver and release is understood to supercede and take precedence over any other agreement or representation, whether written or oral, which contradicts the terms of this waiver.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AND FULLY UNDERSTAND ITS TERMS. I FURTHER UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS FORM, AND HEREBY SIGN IT FREELY, VOLUNTARILY AND WITHOUT ANY INDUCEMENT.

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Participant’s Signature Participant’s PRINTED Name Date

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Emergency Contact Person Emergency Phone Number

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Participant’s Address

MINOR PARTICIPANT

(Under the age of 18 at the time of registration)

This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all Releases from any and all liabilities to my minor child’s involvement or participation in these programs as provided above.

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Parent/Guardian Signature Date