THIS IS A RELEASE

INSTRUCTIONS

1. Applicants age 18 and over, complete Part “A” only.

2. Applicants under age 18 must have parent or guardian complete Parts “A” and “B”.

PART A - WAIVER AND RELEASE FROM LIABILITY

1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE North Coast Inline, Inc, dba Inline Certification Program, it’s employees, sponsors, other participants, operators, officials, any persons the activity area, sponsors, advertisers, owners and lessees of premises used to conduct the event/clinic/class and each of them, their officers and employees, all for the purposes herein referred to as “releasees”, from all liability to the undersigned, his personal representatives, heirs and next to kin for any and all damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in or upon the restricted area, and/or, competing, officiating in, observing, or working for, or for any other purpose participating in the event or lesson-in person or virtual.

2. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the 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 the restricted area or in any way competing, officiating, observing, or working for, or for any other purpose participating in the event and whether caused by the negligence of the releases or

otherwise.

3. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releasees or otherwise while in or upon the restricted area and/or while competing, officiating, observing, or working for, or for any other purpose participating in the event.

4. EACH OF THE UNDERSIGNED expressly acknowledges and agrees that the activities at the event and in the restricted areas 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 the law of the Province or State in which the event is conducted 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 event sanctioned, authorized or promoted by said releases during the entire season and applies to each and every event, or activity herein above mentioned, and has the same effect as if executed after each and every activity 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 event herein above described.

Signed

Date

Address

State

Zip

Phone #

PART B - PARENT/GUARDIAN WAIVER-RELEASE FROM LIABILITY

(If applicant is under 18 years of age, the parent(s) or guardian(s) must execute in addition to the above, this following

waiver.)

The undersigned, _________________referred to as the parent(s) and

natural guardian(s) or legal guardian(s) of _______________________________________, does hereby represent that he/she(they) is(are), in fact, acting in such capacity and agrees to save and hold harmless and indemnity each and all of the parties herein referred to above as releasees from all liability, loss, cost, claim, or damage whatsoever may be imposed upon said releasees because of any defect in or lack of such capacity to so act and release said releasees on behalf of both of the undersigned.

NAME

RELATIONSHIP TO MINOR

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