Gymnastics Waiver & Draft Form
Liability Release and Automatic Payment Authorization
I fully understand that they YMCA of Ross County staff members are not medical practitioners or physicians of any kind, with the exception of select staff being trained in basic first aid and CPR. With the above in mind, I release the YMCA of Ross County staff to render standard first aid and/or CPR to the below child in the event of any illness or injury if deemed necessary, while awaiting the arrival of more advanced medical care. I further release the YMCA of Ross County to call the child's doctor and seek medical help, or to call emergency medical services for the injured child should the staff deem it necessary. The staff recognizes our obligations to make students aware of the risks and hazards associated with the sport of gymnastics, tumbling, cheerleading, and dance. These activities can be dangerous and have inherent risks of injuries, such as paralysis or death resulting from landings, falls, or blows to the head, back, or neck. The YMCA of Ross County, its coaches, and other staff will not accept responsibility for injuries sustained by any student in the course of these activities or while traveling to or from related events. Being fully aware of the risks and possibilities of injury involved, I consent to have the below child participate in the programs offered by the YMCA of Ross County. I waive and release all rights and claims for damages that I or the below child have against the YMCA of Ross County and/or its representatives, whether paid or volunteer. I affirm that I have and will continue to provide hospitalization, health and accident insurance coverage, which I consider adequate for the child's protection.
The bank or credit card draft is a continuous payment until terminated by the member. You must completed the online withdraw (www.rosscountyymca.org/gymnastics) by the 20th of the month to stop the following month's draft. The automatic withdraw begins on the 2nd day of the month. Monthly program dues are subject to increase when changing class levels. Return Drafts: Please notify the front desk of any account changes as soon as possible to prevent any other draft charges. If a draft is returned for any reason from the bank or cardholder, there will be additional charges applied to the account. Unpaid program fees will result in cancellation of registrations and removal from class.
Name of Program/Class
Day & Time of Class
Parent's Name (as Signature). By typing my name below, I acknowledge that I have read and agree to the above statements and consent to the monthly draft payment for these programs.
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