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* 1. Name of Skater

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* 2. Have you read the COVID-19 Safety Policy?

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* 3. 1. ACKNOWLEDGMENT OF INHERENT RISK
I understand that participation in skating, figure skating, and any other sporting activities listed in the
enclosed appendix (hereinafter the “Sports Activity”) is voluntary, and involves inherent risk during
participation, including the risk of possible accidents, physical injury, or exposure to the COVID-19 virus
or other infections or infectious diseases as a result of attending training, club events or competitive
events. I freely accept and fully assume all such risks, dangers and hazards, including but not limited to
personal injury, disease transmission, death, property damage or loss, resulting from my participation. I
have carefully considered the risks involved, and I have full confidence that reasonable precautions will
be taken to ensure the safety and well-being of myself (or my son/daughter/ward).

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* 4. 2. WAIVER
I do for myself (or my child), and our respective heirs, executors, administrators, successors and assigns,
hereby waive, release, and forever discharge Skate Canada and/or [Skate Canada BC/YK Section], [all
Regions of Skate Canada BC/YK Section], POCO Skating Club, their officers, partners, agents, employees,
servants, representatives, volunteers, coaches, officials, successors and assigns (the “Representatives”)
of and from any actions, causes of action, complaints, demands and claims or any recourse whatsoever
(“Claims”) that I have or may have in the future in any way connected with my (or my child’s)
participation in the Sports Activity contemplated herein, whether in law or in equity, in respect of
personal injury, illness or disease transmission, loss of life, or property damage of any kind or nature,
and I do hereby discharge the Representatives from any such liability. This includes negligence, breach
of contract or breach of any statutory or other duty of care.

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* 5. 3. INDEMNIFICATION
I further agree to fully indemnify and defend Skate Canada and/or [Skate Canada BC/YK Section], [all
Regions of Skate Canada BC/YK Section], POCO Skating Club and any of their Representatives from and
against any and all Claims brought against Skate Canada and/or [Skate Canada BC/YK Section], [all
Regions of Skate Canada BC/YK Section], POCO Skating Club and any of their Representatives, including
all related costs and expenses, and against any loss, costs, damages, or expenses which Skate Canada
and/or [Skate Canada BC/YK Section], [all Regions of Skate Canada BC/YK Section], POCO Skating Club
and any of their Representatives may sustain, suffer, incur, or be liable for resulting from, arising from,
or in any way related to my (or my son/daughter/ward’s) participation in the Sports Activity. I also agree
and undertake not to make any claim or take any proceedings against the Representatives set out
above, or any other person or corporation which might claim contribution or indemnity under the
provisions of any statute or otherwise from the Representatives set out above.

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* 6. 4. SEVERABILITY
The provisions of this Assumption of Risk and Waiver shall be deemed severable and if any provision or
portion thereof is held invalid, illegal or unenforceable for any reason, the remainder shall not thereby
be invalidated, but shall remain in full force and effect.

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* 7. Acknowledgement: I am aware of the nature and effect of this Assumption of Risk and Waiver and I fully
understand all of the terms and conditions above. I understand that I have given up substantial rights by
signing this Assumption of Risk and Waiver and I am signing it freely and voluntarily without
inducement.

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* 8. Parent/Guardian: I certify that I am the parent or legal guardian of the participant named below and
that I am entitled to his or her custody and control. I understand the aforesaid inherent risks that could
arise from these activities, I grant permission for my son/daughter/ward to participate in the Sports
Activity and other activities incidental thereto and I execute this Assumption of Risk and Waiver on
behalf of myself and my son/daughter/ward.

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* 9. Participant's Signature (regardless of Age) Texting/type in counts as legal signature and date of birth

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* 10. Parents Signature (typed in name electronically and legally sufices as signature) and date of signature

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