Amt Pd._____________
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Week: June 2-6 or 9-13 (please cirlce one, or both)

Name:_________________________________________________________________________________ Age:__________ Phone:_____________________

Email: _______________________________________________________

Each person in attending A Good Place for Fun Inc., and using the facilities does so at his or her own risk. The operator of A Good Place for Fun Inc., shall not be liable for any damages arising from personal injuries sustained by any person in or about the premises. Each person assumes full responsibility for all injuries and damages which may occur in or about the premises and he or she does hereby fully and forever release and discharge A Good Place for Fun Inc., operator, owners, officers, independant contractors**, employees and agents from any and all claims, demands rights of action, present or future, resulting from or arising out of the use of A Good Place for Fun Inc. dba The Lexington Ice Center or its facilities. This agreement and waiver, having been read thoroughly and understood completely, is signed voluntarialy as to its contents and intent. ** All professional skating instructors are independant contractors.

Parent/Guardian:_____________________________________________ ________________________________________________Date:______/______/_____