Waiver - Action Park Alliance

Are you a returning customer?(Required)

Yes

No

Who will be participating?(Required)

Adult (18+ only)

Adult and Minor(s) (Parent/guardian + children)

Participant Full Name(Required)

Date of Birth(Required)

Today's Date(Required)

Auto-filled when possible.

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Email(Required)

Emergency Contact Name(Required)

Emergency Contact Phone(Required)

Minor Participant(s)

Complete this section only if a parent/guardian is signing for minor participant(s).

Parent/Guardian Full Name(Required)

Relationship to Minor(s)(Required)

Names of Minor Participant(s)(Required)

List each minor’s full name and date of birth.

Preferred Activities(Required)

Skateboard

BMX

Scooter

Inline Skate

Quad Skate

Driver License or State ID Card Number(Required)

Used for identity verification if needed.

Are you allergic to any medications?(Required)

No

Yes

If yes, list medication allergies

SKATEPARK WAIVER & RELEASE FORM

PARTICIPANT RELEASE OF LIABILITY—READ BEFORE SIGNING

In consideration for being allowed to participate in any way at La Quinta X Park skatepark, its related events, and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury to me does exist; and,
I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees (as defined below) or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary rules, terms and conditions for participation. If I observe any unusual significant concern in my readiness for participation and/or in the program itself, I will remove myself from participation and bring such to the attention of the nearest La Quinta X Park skatepark official immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold harmless Action Park Alliance, Inc., Spohn Ranch, Inc, the City of La Quinta, California and their officers, elected officials, agents, employees, other participants, sanctioned events, sanctioned organizations, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of La Quinta X Park Skatepark (“Releasees”) from any and all claims arising out of my presence at La Quinta X Park skatepark, including, but not limited to, claims for any and all injuries, 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, including attorney’s fees and attorney’s fees on appeal.

MEDICAL RELEASE: In the event that I am unconscious or otherwise unable to make medical decisions for myself in an emergency, I hereby give permission for medical treatment and related transportation to secure proper treatment, and to order anesthesia, for myself as named above.

La Quinta X Park Skatepark
46150 Dune Palms Rd
La Quinta, CA 92253

Agreement (required)(Required)

I have read and agree to the waiver and release above.

Photo / Media Release

I consent to the use of my photograph or likeness for promotional purposes.

Email Marketing Opt-In

Yes – send me emails about events, updates, and promotions.

Optional. You can unsubscribe anytime.

Signature(Required)

Typed Signature (backup)

If you cannot draw your signature, type your full legal name.

Typed Signature Certification

By typing my name above, I sign this waiver electronically and agree that this is my legal signature.

La Quinta X Park

Liability Waiver

Minor Participant(s)

SKATEPARK WAIVER & RELEASE FORM