Name ________________________________________________________________________________ Address _____________________________________________________________________________ City ______________________________________________ Postal code _____________________ Tel.(res.) ___________________________________ (other) ______________________________ Email ________________________________________ Date of birth ________________________ Gender: [ ] Male [ ] Female Type of skater: [ ] Fitness [ ] Competitive Registration fee: [ ] $45 [ ] $65 family IMPORTANT: I have red and understood the Roller-Montréal skater's code. WAIVER, RELEASE AND DISCHARGE: I, the undersigned, hereby RECOGNIZE that the risk of physical injury (including death), or property damage is inherent in the sport of skating (inline or ice), and DECLARE freely and voluntarily that I accept these risks as a normal part of my participation in this sport during an outing, skate, programme, and/or other event or activity whatsoever or while travelling or away for any skating event (hereinafter "Activities") that may be organized by Roller-Montréal, its officers, directors, administrators, employees, volunteers, agents, representatives, affiliates, associates, independent contractors or assigns (hereinafter "Roller-Montréal"). I FULLY UNDERSTAND that as a member, I am OBLIGED to wear a HELMET as well as any other protective gear to help prevent injury. Should I choose not to wear any such protective gear, other than the HELMET which I understand is OBLIGATORY, then I FULLY UNDERSTAND that I choose to do so at MY OWN RISK and hereby ACCEPT COMPLETE RESPONSIBILITY for any physical injury or property damage that I may suffer as a result of my participation in Roller-Montréal Activities. I therefore freely and voluntarily AGREE NOT TO SUE, WAIVE, RELEASE and DISCHARGE Roller-Montréal from any claims, liability or whatsoever that may result from said physical injury or property damage that I may sustain notwithstanding any NEGLIGENCE on the part of Roller-Montréal. This WAIVER IS BINDING not only on the undersigned, but on members of my family, my heirs, successors, legatees, liquidators, assigns, mandataries, representatives, legal and otherwise, and any other person that may have a claim to my succession. AND I HAVE SIGNED THIS ____________________________________ AT _________________________________ SIGNED __________________________________________________________ I, the undersigned, holder of parental authority or as tutor of the aforesaid minor do hereby declare having read and understood the above-mentioned declaration, waiver, release and discharge and consent that my child participate in Roller-Montréal Activities. AND I HAVE SIGNED THIS ____________________________________ AT _________________________________ SIGNED __________________________________________________________