CLUB CERTIFICATION

I hereby approve the entry of the skater(s) and certify that he/she is a member of my club in good standing and to the best of my knowledge is eligible to enter the event specified, is eligible in accordance with USFSA rules, and is following a standard and complete educational program in full compliance with the performer’s home state.

Club Official’s Name Printed: _________________________________________________ Date. _____________________

Club Official’s Title:________________________________________Club Official’s Phone #________________________

Club Official’s Signature _________________________________________________

CONSENT OF PARENT OR GUARDIAN

(For performers under 18 years of age)

I am the parent or legal guardian of____________________________________________________

I understand that my child/ward will be participating in the 1999 CCIA Novice/Advanced Competition at the Redwood Empire Ice Arena. I understand that ice skating can be a dangerous and injurious sport. I accept full responsibility for ensuring that my child/ward is adequately supervised and controlled while on the Redwood Empire Ice Arena property, and accept responsibility for accidents or injuries to myself or my child/ward, and for property damage, arising as a result of said activity. I hereby waive all rights to assert or levy and all claims, losses, liabilities, costs and/or liens against the corporations known as the Redwood Empire Ice Arena, and the organization known as “United States Figure Skating Association” and/or “Santa Rosa Figure Skating Club”. I agree to indemnify, defend and hold harmless the Redwood Empire Ice Arena, United States Figure Skating Association, Santa Rosa Figure Skating Club”, and these corporations’ and organizations’ officers, management, agents and staff from and against any and all claims, losses, liabilities, costs and/or liens for accidents or injuries to my child/ward, or any other person or property damage caused by or arising out of their participation in this competition. If I am unable to supervise and control the activities of my child/ward while on the Redwood Empire Ice Arena property, I agree to provide all necessary medical consents, medical information, and emergency numbers to persons of suitable age and discretion who have agreed to supervise and control my child/ward. I have signed this form in my individual capacity, and on behalf of my child/ward, and his/her heirs, executors and/or administrators.

Name____________________________________________ Capacity______________________________________________
(Please print your name)                                     (Parent or Guardian)


Signature_______________________________________________________ Date ______________________

ASSUMPTION OF RISK AND WAIVER OF LIABILITY

(Of adult performers, 18 years of age and over)
I understand that ice skating can be a dangerous and injurious sport. I assume full responsibility for my own risk of injury. As a participant, I understand and accept the full risk and financial responsibility of my participation in the competition and waive all rights to assert or levy any and all claims, losses, liabilities, costs and/or liens against the corporations known as the Rwedwood Empire Ice Arena and the organization known as “United States Figure Skating Association” and/or “Santa Rosa Figure Skating Club”. Furthermore, I waive the rights of my heirs, executors and/or administrators of my estate to assert or levy any and all claims, losses, liabilities, costs and/or liens against the aforementioned corporations and organizations. I agree to indemnify, defend and hold harmless the Redwood Empire Ice Arena and the organization known as “United States Figure Skating Association” and/or “Santa Rosa Figure Skating Club”, and these corporations’ and organizations’ officers, management, agents and staff from and against any and all claims, losses, liabilities, costs and/or liens for accidents or injuries to myself, or any other person or property damage caused by me or arising out of my participation in this competition.

Name____________________________________________ Signature______________________________________________
(Please print your name)                                     ( Adult Skater’s signature)

Date : ____________________________________

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