Razzle Dazzle Clinic Participation Permission Slip

Child's Full Name*

First NameLast Name

Child's Birth Date*

MonthDayYear

School*

Grade*

Home Room Teacher:*

Child's Allergies or medical problems*

N/A for no allergies or medical problems.

Days Attending (Check all that apply)*

Parent/ Guardian Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

example@example.com

Home Phone Number

Area CodePhone Number

Cell Phone Number*

Area CodePhone Number

Emergency Contact Name*

First NameLast Name

Relationship*

E-mail*

example@example.com

Home Phone Number

Area CodePhone Number

Cell Phone Number*

Area CodePhone Number

10. Release and Indemnification*

I voluntarily agree to assume the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may incur by reason of Youth Spirit Squads activity (“Claims”).I hereby release and covenant not to sue Youth Spirit Squads, Razzle Dazzle, Vogue Athletics or anyone with any affiliation to these entities, its affiliated organizations, employees, volunteers, agents, and representatives, of and from the Claims.I am aware that participating in any type of athletic activity such as, but not limited to, Private Tumbling Lessons, Open Gym Lessons, All-Star Practice, and Team Practices at Youth Spirit Squads under Razzle Dazzle or Vogue Athletics at 2420 Comanche Blvd NE, Ste B-3 in Albuquerque, NM 87107 or any designated practice space can be a dangerous activity involving many risks of injury.I understand that the participant is healthy enough to participate and he/she has been cleared by a health care professional.I understand the dangers and risks of participating may include but are not limited to: death, serious neck injury, serious spinal cord injury which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, serious injury to all bones, joints, ligaments, muscles, tendons, and other areas of the muscular skeletal system, serious injury or eye impairment, and serious injury to other areas of my body, general health and well-being.I voluntarily agree to allow myself or my child(ren) to participate in any type of athletic activity such as, but not limited to, Razzle Dazzle Clinics/Practices, Private Tumbling Lessons, Open Gym Lessons, All-Star Practice, etc. and assume all risks associated with voluntary participation.I agree to hold any Youth Spirit Squads or it’s Affiliates Members free from any and all liability, actions, causes of action, debts, claims, or demands of any kind or nature whatsoever which may arise by or in connection with my participation in any activities related to this extra practice.The terms hereof shall serve as a release and assumption of all risk for my heirs, estate, executor, administrator, assignees, and for all members of my family. This waiver will remain in place for 1 year from the date signed.

11. Permission to Participate*

As the parent/guardian, hereby attest that I have carefully read this Permission to Participate in YSS Inc. (dba - Razzle Dazzle) clinics, practices, and events, and understand its contents, and agree to all terms and conditions contained therein.

12. Age of Consent*

I am an adult over the age of eighteen (18).

Signature*

Please sign above

Date

Permission to Participate in Razzle Dazzle Clinics

1. Activity Supervisors

2. Transportation

3. Requirements

4. Consent

5. Authorization:

6. Emergencies

7. Insurance

8. Emergency Contacts

Parent/Guardian Contact Information

Emergency Contact Information