ISLE OF WIGHT COUNTY SKATE PARK ASSUMPTION OF RISK WAIVER AND INDEMNITY AGREEMENT

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Lawrence Lloyd
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1 ISLE OF WIGHT COUNTY SKATE PARK ASSUMPTION OF RISK WAIVER AND INDEMNITY AGREEMENT To be filled out by Participant or Parent/ Legal Guardian, if Participant is under the age of 18: NAME: BIRTH DATE: - - AGE: ADDRESS: SCHOOL: GRADE: PHONE: ( ) MALE or FEMALE (circle one) Emal Address: NAME OF LOCAL EMERGENCY CONTACT: PHONE NUMBER OF LOCAL EMERGENCY CONTACT: ( ) RELATIONSHIP TO PARTICIPANT: In consideration of the opportunity to participate in the use of the skate park at Nike Park Road, Carrollton VA in Isle of Wight County (the Skate Park ), the undersigned Participant hereby agrees as follows: 1. Participant acknowledges and understands that there are risks of injury and damage associated with the use of the Skate Park. Such risks include but are not limited to personal injury, broken bones, concussions, paralysis, death and/or property damage. There may be physical maneuvers, twists, turns, movements, evasion techniques and conduct that may pull, strain or break body parts. Participant and Parent/Legal Guardian have both read the attached Isle of Wight County Skate Park Rules and Skateboarding Safety and understand the contents. 2. With the knowledge of the foregoing, Participant hereby assumes the full risk of any personal injury and property damage, including but not limited to broken bones, concussions, paralysis, death, and/or property damage that might occur while Participant is participating or engaging in an activity or activities at the Skate Park. 3. With the knowledge of the foregoing, and as an inducement for Isle of Wight County to allow me to participate, Participant hereby RELEASES AND WAIVES any and all claims or causes of action against Isle of Wight County, its divisions and subdivisions, including but not limited to the Isle of Wight County Parks and Recreation Department, their agents, staff and employees (collectively the County ) for injuries, damages, losses and expenses arising out of Participant s participation and engagement in any activity on property owned by Isle of Wight County, its divisions and subdivisions. 4. Participant hereby agrees to INDEMNIFY AND SAVE HARMLESS, the County from any and all claims or causes of action which I may make or which might be made on my behalf by others, or which might be made against the County by others, arising from or related to my participation, including but not limited to death, injury, pain and suffering, medical costs, lost wages, destruction of property, attorneys fees and legal expenses. 5. This Agreement shall remain valid until revoked in writing with receipt acknowledged by the County, and shall be binding on the Participant s heir(s), executor(s) and personal representative(s). By signing this Agreement, I understand that I am giving up, (waiving and releasing) any right I might have to sue or make a claim which I might have or which might subsequently arise or occur against the County for any injuries I might sustain; and that I am indemnifying and holding harmless the County against claims and causes of action arising from my participation, and I do so knowingly and voluntarily after careful reflection. IF PARTICIPANT IS UNDER THE AGE OF 18, BOTH THE PARTICIPANT AND HIS/HER PARENT/ LEGAL GUARDIAN MUST SIGN PARTICIPANT SIGNATURE: DATE: PRINT NAME: PARENT/LEGAL GUARDIAN SIGNATURE: DATE: PRINT NAME: RELATIONSHIP TO PARTICIPANT: Page 1 of 6

2 ISLE OF WIGHT COUNTY SKATE PARK RULES THIS SKATE PARK IS UNSUPERVISED. USE OF THIS SKATE PARK IS AT YOUR OWN RISK. AUTHORIZED PARTICIPANTS ONLY. TO BE AUTHORIZED, PARTICIPANTS MUST SIGN AN ASSUMPTION OF RISK WAIVER AND INDEMNITY AGREEMENT WITH THE COUNTY OF ISLE OF WIGHT PRIOR TO SKATING. A DECAL STICKER VERIFYING THAT THIS AGREEMENT HAS BEEN SIGNED WITH THE COUNTY OF ISLE OF WIGHT MUST BE DISPLAYED ON THE PARTICIPANT S HELMET AT ALL TIMES. FORMS MUST BE FILLED OUT AT THE ISLE OF WIGHT COUNTY PARKS AND RECREATION OFFICE LOCATED AT Nike Park Road, Carrollton VA THE SKATE PARK IS OPEN FROM DAWN UNTIL DARK, SEVEN DAYS A WEEK. ENTERING THE SKATE PARK AFTER IT IS CLOSED WILL BE CONSIDERED TRESPASSING. THE SKATE PARK IS FOR SKATEBOARDS, BMX BIKES AND IN-LINE SKATE USE ONLY. ALL PARTICIPANTS MUST WEAR PADS AND HELMETS WITH CHINSTRAPS AT ALL TIMES. NO GLASS CONTAINERS, BREAKABLE OBJECTS, FOOD, GUM, ALCOHOLIC BEVERAGES, DRUGS, TOBACCO PRODUCTS, MOTORIZED DEVICES, UNAUTHORIZED RAMPS/OBSTACLES OR PETS ARE ALLOWED IN THE SKATE PARK AREA. PLEASE DISCARD GARBAGE IN TRASHCANS. ALL PARTICIPANTS MUST BE 5 YEARS OF AGE OR OLDER. CHILDREN UNDER 12 YEARS OF AGE MUST BE ACCOMPANIED BY AN ADULT. RIDE COURTEOUSLY PARTICIPANTS WITH DIFFERENT ABILITIES ARE USING THE SKATE PARK. ONLY ONE PARTICIPANT PER ELEMENT AT A TIME. ONLY AUTHORIZED PARTICIPANTS ARE ALLOWED INSIDE THE SKATE PARK AREA. ALL OTHERS MUST REMAIN OUTSIDE THE FENCE. ROUGH PLAY, EXCESSIVE NOISE AND ABUSIVE BEHAVIOR OR LANGUAGE TOWARDS OTHER PARTICIPANTS WILL NOT BE TOLERATED. ANYONE NOT USING THE SKATE PARK IN A SAFE AND ACCEPTABLE MANNER WILL BE REMOVED OR BANNED FROM THE SKATE PARK. IF PARTICIPANT IS UNDER THE AGE OF 18, BOTH THE PARTICIPANT AND HIS/HER PARENT/ LEGAL GUARDIAN MUST SIGN PARTICIPANT SIGNATURE: DATE: PRINT NAME: PARENT/LEGAL GUARDIAN SIGNATURE: DATE: Page 2 of 6

3 PRINT NAME: RELATIONSHIP TO PARTICIPANT: Skateboarding Safety Skateboarding is an increasingly popular recreational activity among teenagers-especially young males. Practice skateboarding safely and use protective equipment. It is a fun and healthy sport that can give you a low-impact aerobic workout. The American Academy of Orthopaedic Surgeons encourages physical activity as part of an overall health and fitness plan. You can have fun, but it is always important to be safe! Incidence of Injury To improve skateboarding safety, a growing number of communities provide supervised skateboard parks. These may have professionally designed "bowls" and "ramps" or other designated skateboarding areas that are located away from motor vehicle and pedestrian traffic. Skateboarding is an activity in which you move quickly over hard surfaces. It can lead to injuries that range from minor cuts and bruises to catastrophic brain injury. Each year in the United States, skateboarding injuries cause about 50,000 visits to emergency departments and 1500 children and adolescents to be hospitalized. (Source: AAP, March 2002) Most hospitalizations involve head injury. Even injuries that heal quickly can cause pain and anxiety, cost time, and money and may lead to disabilities. This can include loss of vision, hearing and speech; inability to walk, bathe, toilet, dress or feed yourself; and changes in thinking and behavior. Skateboarding is not recommended for young children. That's because they are still growing and do not yet have the physical skills and thinking ability a person needs to control a skateboard and ride it safely. According to the American Academy of Pediatrics (AAP): Children under age 5 years old should never ride a skateboard. Children aged 6 to 10 years old need close supervision from an adult or trustworthy adolescent whenever they ride a skateboard. When young children are involved in skateboarding accidents, they are often injured severely. Skateboarding is a special risk for young children because they have: A higher center of gravity, less development and poor balance. These factors make children more likely to fall and hurt their heads. Slower reactions and less coordination than adults. Children are less able to break their falls. Less skill and ability than they think. Children overestimate their skills and abilities and are inexperienced in judging speed, traffic and other risks. Page 3 of 6

4 Serious skateboarding injuries happen when you lose control and fall or run into a motor vehicle, road hazard, pedestrian, another skateboarder or bicyclist. You are at risk for injuries: If you don't use protective equipment. If you don't keep your skateboard in good condition. If you skateboard on irregular surfaces. If you attempt "tricks" beyond your skill level. Sixty percent of skateboard injuries involve children under age 15; most of those injured are boys. At highest risk are: Inexperienced skateboarders. Those who have been skating for less than one week suffer one-third of injuries, usually caused by falls. Skateboarders who do not wear protective equipment. Every skateboarder should wear standard safety gear. This includes a helmet, wrist guards, elbow and knee pads and appropriate shoes. Skateboarders who perform tricks should use heavy duty gear. Skateboarders who go near traffic or use homemade skateboard ramps. Both activities are particularly dangerous. Experienced skateboarders who encounter unexpected surfaces or try risky stunts. Irregular riding surfaces, rocks or other debris can cause you to fall. You can stumble over twigs or fall down slopes. Wet pavements and rough or uneven surfaces can cause a wipeout. Avoid risky behavior. Don't skateboard too fast or in dangerous or crowded locations. Types of Injury Skateboarding injuries often involve the wrist, ankle or face. Many injuries happen when you lose your balance, fall off the skateboard and land on an outstretched arm. Injuries to the arms, legs, neck and trunk range from bruises and abrasions to sprains and strains, fractures and dislocations. Wrist fractures are quite common. Wearing wrist guards can reduce their frequency and severity. Facial injuries include breaking your nose and jawbone Severe injuries include concussion, closed head injury and blunt head trauma. You can suffer permanent impairment or even death if you fall off the skateboard and strike your head without a helmet. Most brain injuries happen when your head hits pavement. You are most at risk if you skateboard near traffic and collide with motor vehicles, bikes, pedestrians or other obstacles. Prevention You can prevent most skateboarding injuries if you follow all of these recommendations: Use a quality skateboard Skateboards have three parts-the deck (the board itself), the trucks (the mechanism to which wheels are attached) and the wheels. Shorter decks are best for beginners because they are easier to balance and handle. Skateboards have various characteristics for all types of riding including slalom, freestyle and speed. Some are rated for the user's weight. Keep your skateboard in proper working order Page 4 of 6

5 You should inspect it before every ride. Look for problems that need repair. These can include loose, broken or cracked parts; sharp edges on metal boards; a slippery top surface; wheels with nicks and cracks, etc. Get professional help to repair serious defects. Learn the basic skills of skateboarding, especially how to stop properly. Also learn slowing and turning techniques, and how to fall safely: If you are losing your balance, crouch down on the skateboard so you won't have as far to fall. Try to land on the fleshy parts of your body rather than your arms. Relax and roll. Wear proper protective equipment Before getting on your skateboard, empty your pockets of all hard and sharp objects and put on your protective gear. Essential protective equipment includes: A properly fitting helmet Wrist guards Knee and elbow pads Shoes Helmet To protect your head from injury, always wear a properly fitting helmet. This is true no matter what your age, level of experience or location where you are skateboarding. Get a quality bicycle or multi-sport helmet. It should meet or exceed safety standards of the U.S Consumer Product Safety Commission (CPSC) or Snell Memorial Foundation. You may need to try on several sizes and models to find a helmet that fits your head correctly and securely. A properly fitting helmet: Is worn flat on your head with the bottom edge parallel to the ground Sits low on your forehead Has side straps that form a "V" shape around each ear Has a buckle that fastens tightly (there should be room to put only two fingers between the strap and your chin) Has pads inside that you install or remove so the helmet fits snuggly Does not move in any direction when you shake your head Does not interfere with your movement, vision or hearing Replace your helmet when it is damaged, outgrown or at least every five years. You may need to replace it sooner if the manufacturer recommends it. Wrist guards, knee and elbow pads and other gear Wrist guards help support the wrist and reduce the chances of breaking a bone if you fall. Knee and elbow pads reduce the severity of cuts and scrapes, and prevent gravel burns. You should also wear closed, slip-resistant shoes, and consider goggles to keep debris out of your eyes. Skateboard only on smooth pavement away from traffic, preferably in a supervised skate park. Never hold onto the side or rear of a moving vehicle while riding a skateboard ("skitching"). You could fall or be thrown into oncoming traffic if the vehicle suddenly slows, stops or turns. Never use your skateboard in wet weather. Avoid skateboarding in crowded walkways or in darkness. Page 5 of 6

6 Always screen the area before you skateboard, inspecting surfaces for rocks and other debris. Be careful with tricks and jumps. Skateboarding skill is not acquired quickly or easily. Don't take chances by skateboarding faster than your experience allows, or faster than is safe for conditions or the speed of other skateboarders. If you try tricks and jumps, practice them only in a controlled environment, such as a skate park that has adult supervision and appropriate access to emergency medical care. Stay in shape. Prevent skateboarding injuries by keeping in top physical condition. Stretch and do conditioning exercises before and after skateboarding. Do not use headphones while skateboarding. Never put more than one person on a skateboard. Be considerate of fellow skateboarders, especially those who are younger and / or less skilled. Know what to do in an emergency. Skateboarding accidents happen, so you should always know what to do in emergency situations. Don't panic. Call 911 for medical assistance or an ambulance. Last reviewed and updated: October 2007 Reviewed by members of the Pediatric Orthopaedic Society of North America Page 6 of 6

Skate Park Registration Form

William V. Zimmermann Skate Park Registration Form Participant Name Date of Birth Home Phone E-Mail address Street Address City State Zip Code Participant is (please check all that apply): in-line skater