11600 Manchaca Road, Austin, TX 78748 Ph (512) 292-7528
Name of student:
Address:
Parent or Guardian Name:
Home Number:
Work Number:
Cell Number:
Email Address:
Emergency Contact Name:
Emergency Contact Number:
Consent to Participate
WE HEREBY AGREE THAT AUSTIN ROLLER RINK LLC AND ITS MEMBERS, TEACHERS, OR OFFICERS SHALL NOT BE LIABLE FOR ANY INJURY OR LOSS WHICH MY CHILD MAY SUSTAIN WHILE PARTICIPATING IN ACTIVITIES OF ANY KIND WHETHER SPONSORED BY OR UNDER SUPERVISION OF AUSTIN ROLLER RINK LLC AND WE AGREE TO INDEMNIFY AND TO HOLD HARMLESS AUSTIN ROLLER RINK LLC, ITS MEMBERS, TEACHERS, OR OFFICERS OR DESIGNATES OF ANY KIND FROM ANY CLAIM WHATSOEVER.