Roller Skating Liability Waiver
Please complete this form to acknowledge the risks of roller skating and release the facility from liability.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you roller skated before?
*
Yes
No
Do you have any medical conditions or allergies we should be aware of?
Please list any medical conditions or allergies (if any):
Signature (Please sign below to confirm your acceptance of the waiver)
*
Submit Waiver
Submit Waiver
Should be Empty: