Mecklenburg County
Park & Recreation
Grayson SkatePark
FOR YOUR SAFETY THESE POLICIES AND
PROCEDURES WILL BE STRICTLY ENFORCED
All users are required to register, sign in, and pay applicable entry fee at
the Recreation Center Help Desk for admission to the Skate Park
Helmets must be worn at all times on park grounds (16 & under) and in
Skate Park (all users)
All participants are required to wear the following safety equipment:
Helmet, knee pads, and elbow pads
Skating on handrails and steps is prohibited. Only obstacles that have
been furnished by staff may be put into the facility.
Animals/pets, glass, food and beverages, smoking, scooters, and spectators
inside the Skate Park fence are prohibited
Use of facility when park is closed is prohibited. Violators are trespassing
and will be expelled from use of the Skate Park
Skate Park will close for inclement weather
Mecklenburg County is not responsible for lost or stolen items
All participants use Skate Park at their own risk and assume all
responsibility of use
MECKLENBURG COUNTY PARK & RECREATION
SKATE PARKS
Registration
(Please Print)
NAME:___________________________________
Last
First
MI
__/___/___
D.O.B.
_____
Age
_____
Sex
ADDRESS______________________________________________________________
Street
City
State
Zip
HOME PHONE:______________________ CELL PHONE:_____________________
E-MAIL ADDRESS:______________________________________________________
ANY KNOWN ALLERGIES OR MEDICATION:______________________________
PARENT OR GUARDIAN’S NAME:________________________________________
ADDRESS:______________________________________________________________
Street
City
State
Zip
HOME PHONE:______________________BUSINESS PHONE __________________
CELL PHONE:_______________________
EMERGENCY CONTACT’S NAME:________________________________________
RELATIONSHIP TO REGISTRANT: __________________________
HOME PHONE:________________
BUSINESS PHONE: _________________
CELL PHONE:__________________
PUBLICITY AND PROMOTION: I ALSO AUTHORIZE THAT PHOTOGRAPHS OF THE PARTICIPANT MAY
BE PUBLISHED FOR THE PURPOSE OF PUBLICIZING AND PROMOTING THE PROGRAMS OPERATED
AND/ OR SPONSORED BY MECKLENBURG COUNTY PARK AND RECREATION DEPARTMENT.
___________________________________
PARTICIPANT SIGNATURE
_______________
DATE
___________________________________
PARENT OR GUARDIAN SIGNATURE (IF UNDER 18)
_______________
DATE
MCPRD SKATE PARKS
Mecklenburg County Park and Recreation
RELEASE AND HOLD HARMLESS AGREEMENT
Parental consent form for youth under eighteen (18) years of age
The Undersigned, ____________________________as a parent or legal guardian
for______________________________________, date of birth______________, understand and acknowledge the
nature and risk of skate/skateboard activities and do hereby authorize the child’s use of Mecklenburg County’s
Grayson SkatePark facility.
In addition, I/we release and waive all rights to claim or suit against Mecklenburg County, its officials,
employees, agents, and sponsors regarding any and all liability for injuries, death, or property damages arising
from the child’s use of the skate facility and agree to hold the County, its officials, employees, agents, and
sponsors harmless from and against all claims and suits for injury, death, or property damages to the child
and/or others arising from the child’s use of the skate facility. Also, I acknowledge that protective safety gear
(helmet, knee pads, and elbow pads) must be worn at all times by the participant, while using the skate facility.
__________________________________
Parent/Legal Guardian signature
__________________________________________
Child
___________
_______________
Date
Day Time Phone
_____________
Date
SEAL
__________________________________________
Notary Public (Required if not signed at Naomi Drenan
Recreation Center/Grayson SkatePark)
Commission expires:_______________________
Adult Release and Hold Harmless Agreement
The Undersigned, ________________________________as a participant, understands and acknowledges
the nature and risk of skate/skateboard activities.
In addition, I release and waive all rights to claim or suit against Mecklenburg County, its officials,
employees, agents, and sponsors regarding any and all liability for injuries, death, or property damages arising
from my use of the skate facility and agree to hold the County, its officials, employees and agents harmless from
and against all claims and suits for injury, death, or property damages to me and/or others arising from my use
of the skate facility. Also, I acknowledge that protective safety gear (helmet, knee pads, and elbow pads) must be
worn at all times by me, the participant, while using the skate facility. Valid identification is needed for staff
signature.
_____________________________________
Signature
________________
___________
Date
Phone
Recreation Center Staff_______________________________________ Date________
North Carolina Statute 99E-24(a) any person who participates in or assists in hazardous recreational activities assumes the known and unknown
inherent risks in these activities. 99E-24(b) While engaged in hazardous recreational activities, irrespective of where such activities occur, a
participant is responsible for doing all of the following: (1) acting within the limits of his or her ability... (2)Maintaining control of his or her person
and the equipment used. (3) Refraining from acting in any manner that may cause or contribute to death or injury of him or her or other persons.
99E-25(b) No governmental entity or public employee who has complied with G.S. 99E-23 shall be liable to any person who voluntarily participates
in hazardous recreation activities for any damage or injury to property or persons that arises out of a person's participation the activity and that takes
place in an area designated for the activity.