Please complete and sign to demo Romp Skis

Full Name *

Email *

Phone Number *

Street Name *

City *

State *

Zipcode *

Drivers License Number *

Height *

Weight *

Age *

Skier Type *

I
II
III

Boot Sole Length *

Model(s) *

Shepherd 99
Shepherd 110
Zorro 100
Zorro 115
Oso 105
Sidehit
Prototype
Other

Ski Length *

Date Out *

Date Returned *

DIN Requested *

Equipment user or parent/guardian signature:

Clear

I have accurately represented the above and it is true an correct. I will not use any of my equipment until I have received instruction on its use and I fully understand its use and function (including receipt of accompanying manufacturer's instruction pamphlet(s) for new equipment). I agree to verify that the visual indicator windows of the equipment, agree with the number appearing in the visual indicator windows of the equipment to be listed on this form. I agree to read and execute the LIABILITY RELEASE AGREEMENT on the back of this form.

Signature *

Clear

I understand that the binding system cannot guarantee the user's safety. In downhill skiing, this binding system will not release at all times or under all circumstances where release may prevent injury or death, nor is it possible to predict every situation in which it will release.

I understand that the sports of skiing (collectively "RECREATIONAL SNOW SPORTS") involve inherent and other risks of INJURY and DEATH. I voluntarily agree to expressly assume all risks of injury or death that may result from these RECREATIONAL SNOW SPORTS, or which relate in any way to the use of this equipment.

I understand that a helmet designed for RECREATIONAL SNOW SPORTS use will help reduce the risk of some types of injuries to the user at slower speeds. I recognize that serious injury or death can result from both low and high energy impacts, even when a helmet is worn.

I agree to Release and hold harmless the facility servicing this equipment, its employees, owners, affiliates, agents, officers, directors, and the equipment manufacturers and distributors and their successors in interest (collectively "PROVIDERS"), from all liability for injury, death, property loss and damage which results from the equipment user's participation in the RECREATIONAL SNOW SPORTS for which the equipment is provided, or which is related in any way to the use of this equipment, including all liability which results from the NEGLIGENCE of PROVIDERS, or any other person or cause.

I further agree to defend and indemnify PROVIDERS for any loss or damage, including any that results from claims or lawsuits for personal injury, death, and property loss and damage related in any way to the use of this equipment.

This agreement is governed by the applicable law of this state or providence. If any provision of this agreement is determined to be unenforceable, all other provisions shall be given full force and effect.

Date *

I agree Terms and Conditions *

IF UNDER 18: Parent/Guardian: I verify that I am the parent, guardian or agent of the equipment user; I have authority to enter into this agreement on behalf of the equipment user; and I agree to be bound by the terms and conditions of this agreement.

Parent/Guardian signature

Clear

ROMP SKIS DEMO AGREEMENT AND RELEASE OF LIABILITY

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