Mission Valley YMCA Bike & Skate Park Participant Waiver
In consideration of being permitted to enter any branch of the YMCA of San Diego (“YMCA”) for observation, use of facilities and/
or equipment, or participation in any program, I hereby:
1. Acknowlege that (i) I have read this document, (ii) I have inspected the YMCA facilities and equipment, (iii) I accept them as being
safe and reasonably suited for the purposes intended, and (iv) I voluntarily sign this document.
2. Release the YMCA, its directors, officers, employees, and volunteers (collectively “Releasees”) from all liability to me for any loss or
damage to property or injury or death to person, whether caused by Releasees or otherwise and while I/such minor am in or near any
YMCA branch.
3. I agree not to sue Releasees for any loss, damage, injury or death described above and I will indemnify and hold harmless Releasees and
each of them from any loss, liability, damage or cost they may incur due to my/said minor’s presence in, upon or near the YMCA branch;
whether caused by the negligence of the releasees or otherwise.
4. I assume full responsibility for, and risk of, bodily injury, death or property damage due to the negligence of Releasees or otherwise.
I intend this document to be as broad and inclusive as is permitted by the laws of the State of California; if any portion hereof is
held invalid, I agree that the balance shall continue in full legal force and effect.
PHOTOGRAPHIC WAIVER/CONSENT
I give my permission to the YMCA of San Diego County (YMCA) to use my picture or other likeness, or a picture or other likeness of any
of my children, specifically the participant(s) named in this waiver in the YMCA’s general publicity and campaign materials, or to any
other YMCA approved entity for any reason or purpose.
PLEASE FILL OUT LEGIBLY
Skater/Biker’s Name (print): _______________________________ Skater/Biker’s Signature
(over 18 only)
: ______________________
Home Address: __________________________________________ Email: ________________________________________________
City, State, Zip: __________________________________________ Birthday: ____________________________ Age: ____________
Home Phone: ___________________________________________ Work Phone: _________________________________________
Male Female Verify Driver’s Lic.#
(office use only) _________________________________
Emergency Contact Name: ________________________________
Emergency Contact Phone: ______________________________
If Skater/Biker is under 18 years of age, please read and sign below:
Parent’s Release Waiver for children under 18 years of age
1. I, the undersigned parent/person having legal custody/guardianship of the above said minor, give permission for the minor to partici-
pate in all YMCA programs. The minor is physically able and mentally prepared to participate in all activities as described in the
announcement for the program.
2. In consideration of said minor being permitted to enter any branch of the YMCA of San Diego County (“YMCA”) for observation, use
of facilities and/or equipment, or participation of the above in any program, I, on behalf of myself (as parent, guardian, coach aide,
spectator or participant) hereby agree to the above conditions.
3. I do hereby authorize the YMCA as agent for the undersigned, to consent with respect to said minor, to any x-ray examination,
anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered
under general or special supervision of, any physician and surgeon licensed under the provisions of the California Medical Practice Act on
the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. I
understand that the YMCA is not responsible for costs incurred for medical care.
Parent/Guardian’s Name (print): Parent/Guardian’s Signature (if minor):
PARK GUIDELINES
1. Minors must have their parent or legal guardian sign this waiver form in person at the Skate Park office or have this form
notarized. ABSOLUTELY NO EXCEPTIONS!
2. All participants must have either a signed waiver form or a valid Skate Park membership card to enter the park.
3. Waiver forms must be signed in person and participants must present a valid photo I.D. at the Skate Park office.
4. Skating/riding is restricted to the Skate Park only. Skating/riding outside the park may result in suspension of Skate Park privileges.
5. All participants 18 years of age or older are required to wear a helmet with a strap. Elbow pads and knee pads are optional,
but are highly recommended.
6. Parents and spectators are the remain outside the park gates at all times.
7. Food and drinks are to be kept in designated areas only. No glass allowed in the park. Please throw away your trash in the proper
receptacles. Smoking is prohibited on all YMCA property.
8. The YMCA is not responsible for lost or stolen articles. Do not leave valuable items unattended.
9. Be observant of the skaters/riders around you at all times. Please respect your fellow skaters/riders and park staff.