Registration Form
Skater's First Name *
Skater's Last Name *
Mother's Full Name *
Father's Last Name *
Phone Number *
Emergency Phone Number
Email Address *
Program Registering For
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Participants DOB

MM		/
DD		/
YYYY
Participants AGE

Assumption and Acknowledgement of Risks
and Release of Liability Agreement

In consideration of being allowed to participate in any way for Arcadia Ice Arena, the Professional Skaters Association, USA
Hockey, Ice Skating Institute, their related events

1) The Risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death,

and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE

OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3) I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe any unusual

significant hazard during my presence or participation, I will bring such to the attention of the nearest official immediately; and

4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Arcadia Ice Arena L.L.C. the Professional Skaters Association, USA Hockey, Ice Skating Institute, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsor, advertisers, and, if applicable owners and
lessors of premises used to conduct the event ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH,
or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE,
to the fullest extent permitted by law.

5) I hereby give my consent to Arcadia Ice L.L.C./Arcadia Ice Arena to use my image/likenes (or in the case of a child…my child's image/likeness)
for the purpose of inclusion in any publication or advertising related to the Arcadia Ice Arena.
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