The Deker Bauer Foundation
For Suicide Prevention
In order to compete at Deker Bauer Memorial Skateboard Competition & Skate-a-thon 2015, you must do the following:
(check each as it is completed)
____1. Completely fill out all the portions of this form.
____2. The parent ( if participant is under 18 years of age)/participant must sign the bottom of the RELEASE OF LIABILITY
AND ASSUMPTION OF RISK AGREEMENT.
____3. Be at least 10 years of age and older for the Skateboard Competition
____4. Adhere to the rules of the Deker Bauer Memorial Skateboard Competition & Skate-a-thon
____5. Pay the amount of $25.00 Registration fee for the Skateboard Competition
____6. Bring in all pledges for the Skate-A-Thon
____7. Bring one piece of (1) valid ID
Participant’ Name [Last]: ______________________________ [First]: ____________________________
Birth Date (day/month/year): _____/_______/_____
Level: Beginner / Intermediate / Advanced
(Circle correct answer - Skateboard Competition)
Home Phone #: _____________________________ Cell #: ____________________________________
Home Address: _______________________________________________________________________
City: ___________________________________ E-Mail: _____________________________________
Parent’s Name ______________________________ Parent’s Cell #: _____________________________
ALTERNATE EMERGENCY CONTACT
In the event of an emergency, and we are NOT able to reach you (the parent or legal guardian), please provide contact
information for a trusted relative or friend of the family.
Contact Name: ______________________________ Home Phone #: ________________
Cell Phone #: _______________
RULES OF THE SKATEBOARD COMPETITION AND SKATE-A-THON
1.
2.
3.
4.
5.
6.
7.
8.
ONLY SKATEBOARDS WILL BE PERMITTED FOR THE SKATEBOARD COMPETITION
SCOOTERS, BLADES & BIKES WILL BE PERMITTED FOR THE SKATE-A-THON
Helmets are mandatory and must be worn properly – no exceptions.
No alcohol or drugs on property at any time of event.
Foul language is not acceptable – no trash talking
Respect the equipment
Be nice – give way to other participants
Adhere to the rules of the park and competition
Accept Judges decision’s as final. Any rules not followed will result in disqualification.
Please bring signed registration forms on the day of the event with entry fee/ pledges to the registration
table to get your registration package.
RELEASE OF LIABILITY & ASSUMPTION OF RISK AGREEMENT
For the Deker Bauer Memorial Skateboard Competition & Skate-a-thon(Tecumseh Park, Sarnia)
I, ____________________________________, the parent or legal guardian (the “Undersigned”) of the mentioned
minor participant, _____________________________________ (the “Participant”), herby grant permission to the
Participant to participate in the Deker Bauer Memorial Skateboard Competition & Skate-a-thon at Tecumseh Park, I
agree myself and on behalf of the Participant to the following terms, conditions, and requirements:
1. The Undersigned and/or Participant understand, acknowledge, and agree that this agreement applies whether the
Participant is an observer, a bystander, or an active participant.
2. I understand that at all times the Participant must obey and show respect for all The Deker Bauer Foundation For
Suicide Prevention Judges, Organizers, Volunteers and Spectators.
3. I understand that I am financially liable for property damage caused by the Participant.
4. I understand that riding a skateboarding, scooter, biking or rollerblading is dangerous and can result in injury, death
or personal property damage, and I am fully aware of the risks and hazards inherent to such activities and hereby sign up
voluntarily.
5. I understand that that there are various degrees of experience and skill required for using different skating
apparatuses and agree that it will be the Participant’s sole judgment as to what type of manoeuvre/trick he or she will
attempt.
6. The Participant and I understand that helmets are mandatory on the Deker Bauer Memorial Skateboard Competition
& Skate-a-thon at Tecumseh Park property and will be worn properly while participating.
7. I waive all claims and release The Deker Bauer Foundation For Suicide Prevention, the City of Sarnia, and the Deker
Bauer Memorial Skateboard Competition & Skate-a-thon against any and all liability in respect to any loss or damage to
my property, or the Participant’s property.
8. I waive all claims and release The Deker Bauer Foundation For Suicide Prevention, the City of Sarnia, and the Deker
Bauer Memorial Skateboard Competition & Skate-a-thon from and against any and all liability in respect to personal
injury or death to the Participant, expect where such loss or damage is caused or contributed to by The Deker Bauer
Foundation For Suicide Prevention, the City of Sarnia, and the Deker Bauer Memorial Skateboard Competition & Skate-athon from negligence or by such other act or omission for which The Deker Bauer Foundation For Suicide Prevention,
the City of Sarnia, and the Deker Bauer Memorial Skateboard Competition & Skate-a-thon is legally responsible, and the
case of such negligence or other act or omission.
9. The Deker Bauer Memorial Skateboard Competition organizers have my permission to revoke skateboarding privileges
to the Participant due to any violation of the fore mentioned rules.
10. I warrant to The Deker Bauer Foundation For Suicide Prevention, the City of Sarnia, and the Deker Bauer Memorial
Skateboard Competition & Skate-a-thon that the information on this Form (as well as the REGISTRATION FORM) is true,
current and accurate and that I have read and understood all of its content.
11. If any clause in this document is held to be invalid or unenforceable, the remaining clauses continue in effect.
Parent/Legal Guardian’s Signature: ___________________________________ Date: _______________
Participant’s Signature: ____________________________________________ Date: _______________
Skateboard Competition
Competition Age categories:
10yrs -12yrs / 13yrs -14yrs These categories have 3 minute to skate the whole park to show off their skills.
15yrs -16yrs / 17yrs and up Amateur 17 and up experienced These categories will have 5 minutes to skate the whole
park to show off their skills.
There will also be a 10 – 15 minute feature where all participants from each category will show off their skills. There will
be different awards that judges will be looking for to hand out (best kick flip, best Ollie, etc).
Skate-a-thon

ALL AGES PERMITTED
The Deker Bauer Foundation
For Suicide Prevention
PLEDGE FORM FOR SKATE-A-THON
Dear Potential Sponsor,
I am participating in the Deker Bauer Memorial Skateboard Competition & Skate-a-thon. All proceeds will go
towards the opening of a 24/7 drop in center. Please make checks payable to The Deker Bauer Foundation For
Suicide Prevention. Thank you!
Name of Sponsor
Phone #
Address
Amount
Pledged
E-mail
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Participants: To reach our goal, we hope that each participant raises at least $25.00.
Please bring this form to the event on June 6, 2015 with your pledges. There will be prizes for the top 3
people who raise the most money. Thank you for your participation.