SKATE PARK LIABILITY WAIVER

COMPLETE NAME: ___________________________ DATE OF BIRTH: ____________________________

COMPLETE ADDRESS: __________________________________________________________________
__________________________________________________________________
CONTACT NUMBER: _________________EMERGENCY CONTACT NUMBER: ______________________
ID NUMBER: _______________________________ TYPE OF ID: ________________________________

I, ____________________________ hereby acknowledge that I voluntary have applied to participate

and use QUILLA SKATE SHOP’S SKATE PARK FACILITY, I understand that extreme sports such as
Skateboarding and the likes of it are activities that involves risk of injury to me and other individuals.
Using the Skate Park, which includes but is not limited to death, temporary or permanent paralysis,
disability, physical or mental damage as well as damage to my equipment and personal property.
I fully understand that Quilla Skate Shop assume no liability for loss, damage or any kind of injury
sustained by myself or property while using Quilla Skate Shop’s Skate Park, I as an individual assume all
the risk associated using the Skate Park.
By acknowledging and signing the release of liability and using Quilla Skate Shop’s Skate Park, I hereby
fully release and discharge Quilla Skate Shop, including their volunteers and staff from any and all
claims, demands, damage, and rights of action or causes of action present or future. Resulting from or
arising out of my use or intended use of the said park and equipment.
THIS IS A RELEASE OF LIABILITY DO NOT SIGN IF YOU DO NOT UNDERSTAND OR DO NOT AGREE WITH
THIS FORM AND IS VALID EVERYTIME A PARTICIPANT UNDER THE SIGNED NAME USES THE
SKATEPARK.
______________________________ ____________________________
PRINTED NAME & SIGNITURE DATE
FOR PARENTS / LEGAL GUARDIAN OF THE PARTICIPANT UNDER 18 YEARS OF AGE. This is to certify that
I, as a parent or guardian with full legal responsibility for the above named participant. I do consent and
ratify his/her release of Quilla Skate Shop including their volunteers and staff, for myself, my heirs,
assigned, and next of kin, I release and agree to indemnify Quilla Skate Shop Including their volunteers
and staff and all liabilities incident to my minor child’s Involvement or participation in the Skate Park /
facility as provided above, even if arising from negligence of Quilla Skate Shop. To the full extent
permitted by the law. I have carefully read the release, liability, understand and further agreed with its
contents.
THIS IS A RELEASE OF LIABILITY DO NOT SIGN IF YOU DO NOT UNDERSTAND OR DO NOT AGREE WITH
THIS FORM AND IS VALID EVERYTIME A PARTICIPANT UNDER THE SIGNED NAME USES THE
SKATEPARK.
(Please provide copy of letter of consent with valid Identification card and attached to this form)
______________________________ ____________________________
PRINTED NAME & SIGNITURE DATE
 SKATE AT YOUR OWN RISK
 PLEASE BE RESPECTFUL OF THE OTHER INDIVIDUALS USING THE
SKATE PARK
 OPERATION HOURS IS 9:00 AM TO 10:00 PM, NO TRESPASSING
AFTER THE PERMITTED TIME UNLESS ALLOWED BY THE
MANAGEMENT FOR EXTENSIONS
 EXTREME SPORTS IS A HIGH RISK ACTIVITY THAT CAN CAUSE
SEROUS INJURY. THE USE OF HELMETS AND OTHER SAFETY GEARS
IS STRONGLY RECOMMENDED
 SKATE TO YOUR ABILITY AND USE THE SKATE PARK RESPONSIBLY
 PLEASE KEEP THE AREA CLEAN AND USE TRASH RECEPTACLES
 SPECTATORS ARE NOT ALLOWED TO ROAM OUTSIDE THE FACILITY
 NO ALCOHOL
 NO PROHIBITED DRUGS / PLANTS
  DO NOT SKATE WHEN THE SURFACE IS WET OR UNDER
MAINTINANCE
 BAD BEHAVIOR AND RECKLESSNESS IS NOT PERMITTED
 NO GRAFFITI, TAGGING, STICKERS ON THE WALL AND OBSTACLE

QUILLA SKATE SHOP RESERVES THE RIGHT TO EJECT OR BAN FOR LIFE A PARTICIPANT FROM
THE FACILITY FOR REASONS OF SAFETY AND FAIRNESS TO OTHER PARTICIPANT OR
COMPLIANCE WITH THE LAW

THIS IS YOUR SKATE PARK PLEASE USE IT PROPERLY AND DON’T ABUSE IT SO WE CAN SKATE IT FOR A
LIFE TIME.

I have carefully read the rules & regulations, further

understand and agreed with its contents.

______________________________ ____________________________
PRINTED NAME & SIGNITURE DATE
 SKATE PARK SAFETY INSTRUCTIONS

SKATE AT YOUR OWN RISK

HELMET, PADS, SAFETY GEAR STRONGLY RECOMMENDED

PLEASE KEEP THE PARK CLEAN

SKATEBOARDS AND ROLLERBLADES ONLY

NO PROFANITY, DRUGS OR ALCOHOL

QUILLA SKATE SHOP RESERVES THE RIGHT TO EJECT OR BAN FOR LIFE A PARTICIPANT
FROM THE FACILITY FOR REASONS OF SAFETY AND FAIRNESS TO OTHER PARTICIPANT OR
COMPLIANCE WITH THE LAW.

THIS IS YOUR SKATE PARK PLEASE USE IT PROPERLY AND DON’T ABUSE IT SO WE CAN SKATE IT FOR A
LIFE TIME.

I have carefully read the safety instructions further

understand and agreed with its contents.

______________________________ ____________________________
PRINTED NAME & SIGNITURE DATE
 Membership ID application form

Your membership ID entitles you to use the skate park

Prerequisites
1. Filled / signed forms 1, 2 and 3. Supported by a copy of any valid ID’s
1. Skate Park Liability waiver
i. For minors filled out consent form (Page 2)
2. Rules and Regulations
3. Safety Instruction
2. For minors (18 years old and below) need to submit parents’ consent form with supported copy
of valid ID’s
3. Filled out membership ID Form
Strictly NO FILLED OUT / SIGNED FORMS Supported by a copy of any valid ID’s no entry at the skate
park but you can still chill at the staging area or at the shop

Name:

Number: Tel:

Email:

Address:

Country:

Name and contact number in case of emergency:

Note:

For your data security and privacy, we will be encrypting all important data in your Membership ID,
and also a failsafe for counterfeit fake ID.

Sample Member ID