Skate Park Registration Form

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1 William V. Zimmermann Skate Park Registration Form Participant Name Date of Birth Home Phone address Street Address City State Zip Code Participant is (please check all that apply): in-line skater skateboarder FEE $ Please Print: Parent/Legal Guardian Home Phone Cell Phone Street Address City State Zip Code 1 Emergency Information: If Parent/Legal Guardian cannot be reached, please notify: Name Relationship: Phone: Please list any special medications, allergies or medical restrictions Insurance Company (Medical) (optional) Policy/Group Number (optional) PLEASE TURN OVER AND COMPLETE THE WAIVER INFORMATION! City of New Rochelle Doc: Word/OfficeMgr/Skatepark

2 Department of Parks and Recreation Sidney E. Frank Skate Park Release, Waiver, and Hold Harmless Agreement In consideration of the willingness of the City of New Rochelle, Department of Parks and Recreation (the Department ) to provide access to the Sidney E. Frank Skate Park, I hereby waive for myself and on behalf of my child or ward, and any persons claiming by, through or under me or the, any and all claims or causes of action which I or my child or ward now or hereafter may have against the Department, City of New Rochelle, its officers, agents, servants, and employees, for all injuries and damages suffered arising from use of the Skate Park or while at the Skate Park for any other reason. I acknowledge that in-line skating and skateboarding and other physical activities at the Skate Park involve the risk of serious bodily injury and I fully accept and assume all risks and responsibilities for all losses and damages incurred as a result of my participation, and the participation by my child or ward, in these activities. I acknowledge that all persons using the Skate Park pursuant to this Agreement are in good health and good physical condition. I have read the Rules of the Skate Park and understand that full gear is required including but not limited to helmet, elbow and kneepads, and wrist guards, and I will abide by them in full. I have explained the Rules to my child and/or ward and agree that the staff of the Department may deny further use of the Skate Park to any person who violates the Rules. I agree to indemnify, defend and save harmless the Department, and The City of New Rochelle, and its officers, agents, employees, and servants from and against all claims, suits, judgments liabilities and expenses, including attorney s fees, arising out of the use of the Skate Park as contemplated by this Agreement. I have read and understand the above agreement Signature of Parent/Legal Guardian or Participant if 18 or older Date Signed Home Phone Please print: Participant s Full Name

3 William V. Zimmermann SKATE PARK RULES Skaters are expected to follow the rules listed below plus any directions given by the Skate Park staff. Failure to do so may result in the loss of skating privileges, and NO REFUNDS will be given. 1. All skaters must sign in with attendant. 2. All skaters must sign Waiver/Release forms. Minors must have a parent or guardian sign. 3. All skaters assume risk of injury. The City of New Rochelle and its agents are not responsible for any injuries. 4. Skaters must wear proper safety equipment, including but not limited to, helmets, knee and elbow pads, and wrist guards. 5. No trespassing after park hours. 6. Skate Park can only be used when a monitor is on site. 7. No bicycles, roller skates or scooters are permitted inside this facility. 8. No littering. Please use trash containers. 9. Do not use ramps or obstacles that are beyond your ability level. 10. No food or beverages in the skating area. 11. Skaters under 10 years of age must be accompanied by someone 18 years of age or older. 12. No climbing on the fence. 13. No alcohol, smoking, drugs, foul language, inappropriate behavior, glass containers, or loud music. 14. Shirts are required at all times. 15. No headsets or stereo s allowed in the park.

4 William V. Zimmermann Hours of Operation: SIDNEY E. FRANK SKATE PARK At City Park (Fifth Avenue & Potter Avenue) Entrance and available parking in the main City Park parking lot Peak Hours May 1st October 22 nd School Year Weekdays Open 3:30pm to 7:30 pm Summer Weekdays, Weekends and Holidays Open 12:00 noon to 7:00 pm Off Peak Hours October 23 rd April 30 th January/February Closed Weekends, and Holidays Open 12:00 noon to 4:00 pm weather permitting CLOSED ON SCHOOL DAYS, and when the temperature is below 32 degrees For exact days and times monthly, please go to our website Fees: Day Pass $ Time Pass $50.00 For weather closing information Call ½ hour before scheduled opening Please remember even if the weather clears, the park may not be opened due to the dampness of the ramps and/or asphalt. Annual Memberships $ Per Person Annual members receive reduced fees for clinics and camps All memberships expire APRIL 30 TH Skate Park Policy NO REFUNDS

5 PARKS & RECREATION CITY HALL 515 NORTH AVENUE SPECIAL EVENING OFFICE HOURS TUESDAY, JUNE 20, :30 PM 8:30 PM WE WILL BE OPEN LATE TO TAKE SKATE PARK, TENNIS CARD AND OMNICARD APPLICATIONS.

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