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Blasting Notices
Come Skate
Note: fields marked with
*
are required.
Lead Registrant Contact Information
First Name
*
Last Name
*
Email
*
City
*
Phone Number
*
Note: All minors must be accompanied by an adult over the age of 18.
Attendee Information
First Name #1
Last Name #1
Adult or Child #1
Select an option
Adult
Child
Age #1 (if Child is selected)
First Name #2
Last Name #2
Adult or Child #2
Select an option
Adult
Child
Age #2 (if Child is selected)
First Name #3
Last Name #3
Adult or Child #3
Select an option
Adult
Child
Age #3 (if Child is selected)
First Name #4
Last Name #4
Adult or Child #4
Select an option
Adult
Child
Age #4 (if Child is selected)
First Name #5
Last Name #5
Adult or Child #5
Select an option
Adult
Child
Age #5 (if Child is selected)
General Information
Medical Notes
Parent / Guardian Waiver
I, the undersigned parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the Greenstone Gold Mines (GGM) rules and regulations and understand that he/she/I in attending the GGM Come Skate Event (Event) at the Geraldton Arena does so at his/her own risk. GGM shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant and his/her/my family within the described premises. In registering for the Event, I recognize, acknowledge and assume full responsibility for all injuries, damages or loss which may occur on the premises and he/she/I hereby fully release, discharge and otherwise indemnify and hold GGM and its employees harmless from any and all claims, demands, damages, loss, rights of action, present or future resulting from or arising out of any person's participation in the Event, in any manner, in any and all activities connected with or associated with this Event or use of its facilities. In addition, he/she/I fully agree(s) to follow the rules and regulations set by GGM. He/she/I understand(s) that failure to do so may result in suspension from participation. I hereby waive and release all claims for injuries, damages or loss arising out of this program that I or the above participant might sustain. The terms "I", "me" and "my" refer to parent(s)/legal guardian(s) as well as the participants in this event. Photos and videos taken during or after the Event become the property of Greenstone Gold Mines and may be used without compensation or permission. I, the undersigned agree that I will abide by the Greenstone Gold Mines (GGM) rules and regulations and understand in attending the GGM Come Skate Event (Event) at the Geraldton Arena and do so at my own risk. GGM shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained within the described premises. In registering for the Event, I recognize, acknowledge and assume full responsibility for all injuries, damages or loss which may occur on the premises and hereby fully release, discharge and otherwise indemnify and hold GGM and its employees harmless from any and all claims, demands, damages, loss, rights of action, present or future resulting from or arising out of my participation in the Event, in any manner, in any and all activities connected with or associated with this Event or use of its facilities. In addition, I fully agree to follow the rules and regulations set by GGM. I hereby waive and release all claims for injuries, damages or loss arising from the Event that I might sustain. Photos and videos taken during or after the Event become the property of Greenstone Gold Mines and may be used without compensation or permission.
Registration Acknowledgement
Having read the Event Information and Rules, I hereby submit my entry form for registration.
By checking this box I certify that I have read and agree with the above statements.
Submit