Participant Information
Name
Please Select A T-Shirt Size Small
Phone
Date of Birth
Address
City
State
Zip/Postal Code
School
Grade
Do you also?
Participant Email
Parent/Gaurdian Email
Emergency Contact Name
Emergency Contact Number
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 Fairfax County Park Authority, Fairfax County 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 Info

• Wakefield Skate Park on June 19, 2010
Registration: 1:00 PM. Event: 2:00 PM

• All ages/ All Levels. Skate a route through park to raise
money for Children's Hospital National Medical Center in
Washington D.C.

• Registration fee: $15 (if pre-paid by June 18) Day of Event $20.
Includes a free Sk-8 for a Cause T-Shirt.

• Prizes for donations: It only takes raising $25 in donations for Children's
Hospital to receive a prize! Get your Family, friends neighbors or
local businesses to sponsor you.

Please download the SkateFest /Sk8 for a Cause Sponsor Form
Click HERE to download a Sponsor / Donation Form