POINT PLEASANT RECREATION

Date_____________________

Name _________________________________________________

Address ________________________________________________

City State Zip ____________________________________________

Home Phone ________________________Cell Phone ____________

Father= s Cell _____________________________Mother= s Cell ___________________

Date of Birth______________________ Social Security # ________________________

School attended _________________________________________________________

School address __________________________________________________________

Next of Kin_______________________ Phone ________________________________

Address _______________________________________________________________

Insurance Company _________________________________Policy # _____________________________

Signature of Participant ._______________________________________________________

Signature of Parent(  if under age 18) ______________________________________________

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                                                                (Office Use)

Recommended _______Not recommended _________Supt. Of Recreation Date____________

Birth Certificate Checked __________

Rules & Regulations for Use of the

1) All individuals who utilize the skate park shall wear the following safety equipment at all times; Helmet, and shirts. It is highly recommended that all users also wear elbow pads, wrist guards and knee pads.All users must skate responsibly, exercising common sense and courtesy to other users. Note: Only one person per skateboard will be permitted.

2) The facility is for use by skateboards and in-line skate only.

3) Use of the skate park is limited to the posted hours of operation. Any person attempting to use the facility during any other hours shall be subject to fines.

4) The hours of operation are as follows:

    Everyday 1:00pm to Dusk during the local school district year.

    Everyday 10:00am to Dusk from the end of the local school district year to beginning of subsequent school district year.

5) All participants must have their permit on their person at all times while on the premises of the skate park.

6) No activity is permitted when the skating surface is wet, snow covered or icy, or when closed by the Municipality.

7)The use of drugs, tobacco, alcohol, profanity, abusive language/behavior and/or vandalism is strictly prohibited and shall result in the immediate and permanent expulsion from this facility. All rules and regulations cited by the Point Pleasant Borough Ordinances will apply.

8) For safety reasons, admittance to the skate park shall be limited to the established maximum capacity of participants. Spectators must stay clear of skaters and their equipment.

9) Modifications to the skating surface and skating or riding on park structures not specifically designed for that purpose are prohibited.

10) Skateboarding is prohibited in the parking lot adjacent to the skate park.

11) Children under the age of ten(10) must be accompanied by an adult at all times. Children under the age of six(6) are not permitted at any time.

12) No food, drinks, chewing gum, plastic and/ or glass containers or tobacco products are permitted in the skate park.

13) No graffiti, tagging or stickers are permitted on or about the facility.

14) Gear and clothing not in use must be stored outside of the skate park. Shirts and footwear must be worn at all times. The Borough of Point Pleasant is not responsible for lost or stolen items.

15) No organized activity, event or competition shall be permitted in the skate park unless same is sponsored by or authorized by the Department of Parks and Recreation.

16) Skateboarding shall only be permitted within the designated Borough skate park and not on any other Borough- owned properties. Any individual found to be in violation of this regulation shall be subject to the penalty provisions set forth herein.

17) If a card is lost and a replacement card is needed, there will be a $5.00 fee charged to replace the card. This fee is payable upon receipt of the replacement card.

____________________________________________________________________________________________________________________________

I am the Parent/Legal Guardian of

I authorize my child to receive a permit allowing him/her use of the Point Pleasant Borough Skate Park.

I DO HEREBY:

1. Understand that there may be some risks involved with my child= s participation at the skate park, including but not limited to weather conditions, skating surface, skating conditions and equipment.

2. I fully assume the risk associated with the participation in said sporting activity for my child= s participation.

3) I hereby waive any and all claims I have against the Borough of Point Pleasant, the Point Pleasant Recreation Department, its directors, supervisors, officers, or other employees or agents arising out of any personal injury or property damage that is incurred during said participation, whether active or inactive.

4) I fully understand that I am responsible for Medical Insurance for my child. The Borough of Point Pleasant does not carry Medical Insurance for my child.

5) I am responsible to make inspection of my child= s safety equipment and insure that each piece meets the manufacturers safety standards.

6) I have reviewed the terms and conditions of this agreement with my child and consent to his/her participation at the Point Pleasant skate park.

7) I have reviewed the posted rules and regulations for use of the facility with my child and agree to abide by all rules.

8) I understand that my child= s permit may be revoked by the Borough at any time for failure to follow the posted rules & regulations.

Parent/Guardian Signature _______________________________________________________________

Printed Name _____________________________________________Date _______________________

*Form must be signed and presented with Skate Park application to obtain permit.