ALL STAR LEGACY
PARTICIPANT WAIVER, RELEASE OF LIABILITY & MEDICAL AUTHORIZATION
For Birthday Parties, Camps, Clinics, Open Gym, Private Lessons, Special Events & Other Gym Activities
Participant Name:
Date of Birth / Age:
Parent/Guardian Name:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Emergency Contact:
Emergency Contact Phone:
Format: (000) 000-0000.
Event / Program:
Birthday Party
Camp
Clinic
Open Gym
Private Lesson
Other
Date of Event/Program:
ASSUMPTION OF RISK
I understand that participation in cheerleading, tumbling, dance, stunting, gymnastics-related activities, fitness activities, birthday parties, camps, clinics, open gyms, private lessons, and other activities at All Star Legacy involves inherent risks.
These risks may include, but are not limited to, falls, collisions, sprains, strains, fractures, concussions, head, neck or back injuries, illness, equipment-related injuries, and other serious injuries, including permanent disability or death. I understand that these risks may occur even when proper supervision, instruction, equipment, and safety rules are provided.
RELEASE OF LIABILITY
In consideration of the participant being allowed to participate in activities at or through All Star Legacy, I, on behalf of myself, the participant, and our heirs, representatives, and assigns, knowingly and voluntarily release, waive, and hold harmless All Star Legacy, its owners, directors, coaches, instructors, employees, volunteers, contractors, representatives, and facility owners from any and all claims, demands, actions, damages, losses, or liabilities arising out of or related to the participant's involvement in any activity, program, event, or use of the facility.
This release includes claims related to injury, illness, accident, property loss, or damages, to the fullest extent permitted by law.
MEDICAL AUTHORIZATION
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In the event of an injury, illness, or emergency, I authorize All Star Legacy staff, coaches, instructors, or representatives to obtain emergency medical treatment for the participant if I cannot be reached. I understand that every reasonable effort will be made to contact me or the emergency contact listed above. I accept responsibility for any medical expenses incurred as a result of such treatment.
Known allergies, medical conditions, medications, or restrictions:
RULES, CONDUCT & SUPERVISION
I understand that the participant must follow all safety rules, coach/instructor directions, and facility guidelines. I understand that All Star Legacy reserves the right to remove a participant from any activity if the participant is acting in an unsafe, disruptive, disrespectful, or inappropriate manner.
I understand that parents/guardians are responsible for supervising non-participating siblings or guests while on the premises.
PHOTO & VIDEO RELEASE
I give permission for All Star Legacy to photograph or record the participant during activities, events, camps, clinics, birthday parties, or programs. I understand these photos or videos may be used for promotional purposes, including social media, website, flyers, advertising, and other marketing materials.
I agree to the photo/video release
I do not agree to the photo/video release
PERSONAL PROPERTY
I understand that All Star Legacy is not responsible for lost, stolen, or damaged personal items brought into the facility.
ACKNOWLEDGMENT
I have read this waiver and release, understand its terms, and understand that by signing it, I am giving up certain legal rights. I sign this agreement freely and voluntarily.
Parent/Guardian Signature:
Date:
-
Month
-
Day
Year
Date
Printed Name:
Relationship to Participant:
Adult Participant Signature, if 18 or older:
Date:
-
Month
-
Day
Year
Date
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