Participant Information
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Participant Email
Parent/Gaurdian Email
Emergency Contact Name
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Have you been part of a skate team?

Release/ Indemnification Agreement:

I am aware that this activity can be a potentially hazardous activity. Before engaging in any physical activity of this nature, I know I should consult with my physician. I should not enter this event unless I am physically able and trained.  I assume all risks associated with the SK-8 for a Cause, including but not limited to falls, weather conditions, contact with other participants, the effects of the pavement and other courses, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, I, for myself and anyone entitled to act on my behalf, waive and release DMC Companies Inc., T/A Fairfax Surf Shop and the City of Fairfax plus all event partners, sponsors and volunteers, their employees, agents, representatives and successors (collectively “the Sponsors”), from all claims and liabilities of any kind arising out my participation in this skateboarding event.

By signing this release I agree to be bound by and responsible for all the provisions of this release/ indemnification agreement, on behalf of ourselves, the Participant and the successors, representatives, heirs, executors, assigns and transferees of ourselves and the Participants.  We consent to the Participant’s execution of this release and indemnification agreement and participation in the “Go Skateboarding Day” Festival.

Electronic Signature Required
Parent/Gaurdian Name: Date: I ACCEPT
Participant Name: Date: I ACCEPT

SK8 For a Cause Registration Form

• Van Dyck Park on June 21, 2007 starting at 10:00 AM, Registration begins at 9am.

• Raise money for Children's Medical Center and to fund the improvement to the skate park.

•A minimum donation of $15 will get you registered & Sk-8 Cause T-Shirt.
It only takes raising $25 to receive a prize! Prize packages will be given to all participants who raise
$20-50 and $50-100. Top Three Participants who raise the highest amount OVER $100 will win
special prize packages.

• Raise over $100 and get a $25 gift certificate to the Fairfax Surf Shop + Be Eligible for Grand Prize