Private Lesson Registration
Child Name
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First Name
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Phone Number
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Coach Marissa Private Lessons
Appointment
Coach Elizabeth Private Lessons
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Coach Shania Private Lessons
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Release of Liability
THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF Empire ELITE, LLC, USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM EMPIRE ELITE, LLC, IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND EMPIRE ELITE, LLC, HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM. This notice is required by Section 744.301, Florida Statutes (2019). I,voluntarily give our consent for such participation by our son/daughter and execute this release knowingly and willingly in furtherance of such participation. It has been adequately explained to us that cheerleading and tumbling is an activity which may involve airborne inversion of the body and therefore there is an increased potential that any one of the routines involving our son/daughter’s participation could lead to serious injury, paralysis or even death. I/We understand that our son/daughter is required to be in good physical shape and condition and that the activities in which he/she will be asked to participate are strenuous and require physical and athletic agility. It has been fully explained to us that these activities include, but are not necessarily limited to a variety of gymnastics maneuvers, including somersaults, back handsprings, and aerials; that there will be a variety of mounts, tosses, and stunts requiring the coordination of more than one participant on the squad; and that these activities will not be confined to any one site or venue, but rather will involve a variety of sites or venues throughout the year. I/We represent to you that, to the best of our knowledge and belief, our son/daughter has no physical, medical, or mental disability or other limitation that would restrict his/her ability to fully participate in this activity.I/We, by signing this agreement, release Empire Elite, LLC, the coaches, advisors, volunteers, staff, and other members of Empire Elite, LLC from any and all claims, damages, causes of action, or otherwise that we, our son/daughter, our heirs, executors, and assigns, have or may have, now or in the future, arising from any injury or death to our son/daughter, and any claims for loss of or damage to his/her property, which may arise, directly or indirectly, out of his/her participation in the Empire Elite, LLC program. I/We agree to indemnify and hold Empire Elite, LLC harmless from any and all damages that may arise in connection, directly or indirectly, with my/our child’s participation in the program, including, but not limited to, such damage that Empire Elite, LLC may incur in connection with such participation. This Release of Liability, Informed Consent and Acknowledgement Agreement shall continue in full force and effect until such time as revoked, in writing to Empire Elite, LLC, by the undersigned, without limitation as to its duration, as it is acknowledged and understood that my/our child shall participate in cheerleading and/or tumbling activities, including but not limited to, practice, exhibitions, and other related activities, on an on-going basis. I/We agree to allow Empire Elite, LLC to use the image or likeness of my/our child for any purpose deemed applicable to marketing, promotional materials, and/or exhibits without reservation or limitation. We further agree that if any of this document is held invalid, we agree that the balance should continue to be in full legal force and effect. In the event of litigation seeking the enforcement or interpretation of this agreement, the prevailing party shall be entitled to an award of reasonable attorneys’ fees and costs incurred against the other party, including such fees and costs incurred in trial, appellate, and bankruptcy courts. Jurisdiction and venue concerning such litigation shall lie solely and exclusively in Citrus County, Florida. This agreement shall be governed by and construed in accordance with Florida law.
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Tumbling
$45.00
$
45.00
Non Refundable
Number of lessons booked
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2
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5
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Total
$0.00
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0.00
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