7/29/2019 Skate Camp Waiver 2013

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CREDO SKATE CAMPRELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT FOR THE 2013 SKATE CAMn consideration for being permitted to compete, officiate, observe, work for, or for any purpose participate in way at the Skate Camp. EACH OF THE UNDERSIGNED, for him or herself, his personal representatives, heirs, n

of kin, acknowledges, agrees, and represents that he has, or will immediately upon entering the Camp.RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE:

oy Syriac, Credo Skate & Snow Shoppe, and all of their respective directors, counselors, employees, parents, officers, agents,epresentatives, the Camp promoters, participants, premises used to conduct the Camp and each of them, all for the purpose herein refo as releasees, from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any and all loamage, and any claim or demands therefore on account of injury to the persons or property or upon any restricted areas, and/or compefficiating in, observing, working, or for any purpose participating in the Camp.

AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESShe releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in or upon estricted areas or in any way competing, officiating, observing, or working for, or for any purpose participating in the Camp and whetheraused by the negligence of the releasees or otherwise.

ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROERTY DAMAGEue to the negligence of releasees or otherwise while in or upon restricted areas and/or while competing, officiating, observing, working foor any purpose participating in the Camp. EACH OF THE UNDERSIGNED expressly acknowledges and agrees that the activities of the Campangerous and involve the risk of serious injury and/or property damage. EACH OF THE UNDERSIGNED further expressly agrees that theoregoing release, waiver, and indemnity agreement portion thereof is intended to be as broad and inclusive as is permitted by laws of

Massachusetts and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continuen full legal force and effect. THE UNDERSIGNED is not aware of any physical or mental impairment which would be affected by Campersarticipation in the Camp or in Camp activities or exercises. THE UNDERSIGNED agrees to be responsible for all medical expenses andepresents that the camper has adequate medical insurance coverage. THE UNDERSIGNED hereby grants permission to Camp, Camp sponamp promoters, and their assigns, to use his or her voice and/or likeness, photograph and photographs of their equipment in advertising romotion material, feature use including radio, television, or motion picture film, video tape, newspapers, magazines, programs androchures and any and all other media.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEM

RINT CAMPER NAME: DATE:

CAMPER SIGNATURE: DATE:

EGAL PARENT/GUARDIAN SIGNATURE (If competitor is under 18): DATE:

CAMPER SIGN UPThe parent/guardian is responsible for filling out the below information completely and accurately. The parent/guardian is

responsible for dropping off the camper at CREDO SKATE & SNOW SHOPPE before 9am, and for picking up the camper aCREDO at 5pm.

SKATE CAMP WEEK:

CAMPER NAME: CAMPERS AGE:ALLERGIES/OTHER MEDICAL INFO:

EMERGENCY CONTACT:

EMERGENCY CONTACT PHONE:

2ND EMERGENCY CONTACT:

2ND EMERGENCY CONTACT PHONE:

A non-refundable $100 deposit is required to hold the campers spot in the camp. To place this deposit, youmay visit the store at 16 Armory St. Northampton, MA, call us at 413-586-8857, or return this form either to

the store, or to contact@thisismycredo.com with the information below filled out.

*CHECKS ARE NOT ACCEPTED. CASH, CREDIT AND DEBIT ARE ACCPETABLE PAYMENT FORMS

CHOOSE FROM THE FOLLOWING OPTIONS:

CASH $100 DEPOSIT $300 FULL PAYMENT

CREDIT CARD $100 DEPOSIT $300 FULL PAYMENT

NAME ON CARD:

CREDIT CARD NUMBER:

EXPIRATION DATE: SECURITY CODE FROM BACK OF CARD:

Check this box if you are paying the $100 deposit with a credit card, and would like us to chargethis card on the selected week of camp for the remaining $200.