The Deker Bauer Foundation For Suicide Prevention
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.
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