Tumbling Registration and Waiver Agreement

Tumbling Registration and Waiver Agreement

Register for tumbling classes and complete the required waiver and consent agreement.
Participant Information
Participant Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Tumbling Experience/Skill Level
Parent/Legal Guardian Name

First NameLast Name
Parent/Legal Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Legal Guardian Email
example@example.com
Emergency Contact 1
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Conditions
Does the participant have any medical conditions that would prevent or hinder safe participation in the program? If yes, please describe.
If your child requires an inhaler or has other medical conditions, I understand I am required to stay with him/her or get a doctor’s release.
Waiver Agreement
ASSUMPTION OF RISK, MEDICAL AUTHORIZATION, & WAIVER OF LIABILITY

I, (Parent/Legal Guardian), am either the parent or legal guardian of the minor/minors below (Participant’s full name). I am fully aware that participating in gymnastics, tumbling, trampoline, dance, cheerleading, birthday parties, special events, activities, and sports involving height and/or motion may result in illness, injury, permanent paralysis or death to the participant. These activities can include unforeseeable risks including, but not limited to, equipment failure, spotting failure, employee negligence, participant negligence, and acts of natural forces. Being fully knowledgeable of these dangers and risks I ASSUME AND ACCEPT ANY AND ALL RISKS of injury or death associated with our participation.

Allowing my child(ren) to use these facilities, I, on behalf of my child(ren) and our respective heirs, administrators, executors and successors, COVENANT NOT TO SUE AND FOREVER RELEASE, WAIVE, INDEMNIFY AND HOLD HARMLESS Ebony Richardson and Impact Dance & Cheer Company, employee or adult supervisor without limitation damages, injuries or death resulting from participation in Ebony Richardson and Impact Dance & Cheer Company activities and/or unforeseeable risks including acts of negligence.

I also grant permission for Ebony Richardson and Impact Dance & Cheer Company to photograph, record, and use my child’s image, likeness, voice, and/or video for promotional, educational, and marketing purposes in print, online, and social media, without compensation.

If an emergency does arise, I would like my child(ren) to be taken to a hospital for medical treatment and I hold Ebony Richardson and Impact Dance & Cheer Company, its owners and its employees harmless in their retrieving medical care. I hereby agree to individually provide for all possible future medical expenses that may incur as a result of my child’s participation in the Ebony Richardson and Impact Dance & Cheer Company program and/or any injury that occurs during such participation.

Participant shall pay any attorney fees or costs incurred by Ebony Richardson and Impact Dance & Cheer Company in enforcing this agreement.

GUARDIAN OF PARTICIPANT HAS READ CAREFULLY AND FULLY UNDERSTANDS THE CONTRACT AND THE ASSUMPTION OF RISK, MEDICAL AUTHORIZATION AND WAIVER OF LIABILITY. I SIGN THIS OF MY OWN FREE WILL. I acknowledge that I am the guardian and understand the terms of the agreement.
Parent/Legal Guardian's Name (Printed)

First NameLast Name
Parent/Legal Guardian's Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant's Name (Printed)

First NameLast Name
Should be Empty:

Tumbling Registration and Waiver Agreement

Participant Information

Emergency Contact 1

Emergency Contact 2

Medical Conditions

If your child requires an inhaler or has other medical conditions, I understand I am required to stay with him/her or get a doctor’s release.

Waiver Agreement