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Competition Participant Waiver and Release Form Bennetts Creek Park Skate Competition 2012 I am fully aware of the

special dangers and risk inherent in the activity, including physical injury, death, or other consequences that may arise or result directly or indirectly from the activity. Being fully informed as to these risks and in consideration of the privilege of participating in this skateboarding competition, I hereby assume all risk of injury, damage and liability and waive any right of recovery from or to bring suit against the City of Suffolk or HYFY Events for any personal injury, death, or other consequences arising out of my voluntary participation in the activity, except for the sole negligence of the City of Suffolk or HYFY Events.

Participant Printed Name

Participant Signature

Date

(Only required if participant is under 18) I certify that I am the parent or legal guardian of the participant named above; that I have read and understood the foregoing release; and that I join in the release without reservation, granting full consent and authorization for the above named person to participate in the activity.

Parent/Guardian Printed Name

Parent/Guardian Signature

Date

Participant Address

Phone

Emergency Medical Information Form Bennetts Creek Park Skate Competition 2012 Skaters Name Date of Birth Address Hospital Preferred Physician to be called in case of emergency Phone # Allergies Chronic Illnesses Medication Medical Problems Recent Injuries (within last year) Regular Sex: M City Emergency Phone F Zip Phone #

Learning Difficulties Contact Lenses Worn?

Past injuries, illnesses or sports limitations HYFY Events should be aware of:

Competition Participant Appearance Release Form HYFY Events I authorize HYFY Events to make use of my appearance in the Bennetts Creek Park Skate Competition to be used for official business purposes. I agree that you may tape and photograph me, and record my voice during and in connection with my appearance. I agree that any images and sound recordings may be combined with other images, text and graphics, cropped, altered and modified. HYFY Events shall have the right to use these images in the creation of narrative, sound, or moving images without compensation. In giving this consent, I release HYFY Events and the photographer/videographer from responsibility for any violation of personal or proprietary right I may have in connection with the use or any claim, demand, cause, action, suit or proceeding of whatever nature arising out of the above specified use.

Participant Printed Name

Participant Signature

Date