waiver

What is this waiver for?*

Attending a Birthday Party
Attending Jr. Open Gym (18 months - 6 years old)
Attending Sr. Open Gym (6 - 16 years old)
Future / Currently Enrolled Student

*Date of Birthday Party or Open Gym

Dad / Guardian Name*

First Last

Mom / Guardian Name*

First Last

Address*

Street Address City State ZIP Code

Mom's Cell Phone

Dad's Cell Phone

Email*

Child Name 1*

First Last

Child Birthdate*

Child's Gender*

Boy
Girl

Child Name 2

First Last

Child's Birthdate

Child's Gender

Boy
Girl

Child Name 3

First Last

Child's Birthdate

Child's Gender

Boy
Girl

Child Name 4

First Last

Child's Birthdate

Child's Gender

Boy
Girl

Are there any Medial Conditions regarding your child(ren)?*

Acknowledgment and Assumption of Risk

I have informed myself, understand, and am aware of the risks associated with participation in gymnastics, dance and fitness programs and activities (Activities), including the possibility of injury or death. I have informed myself and understand the nature of these Activities, my or my child’s experience and capabilities and believe that I and/or my child is qualified, in good health, and in proper physical condition to participate in such Activities. I understand and acknowledge that the risk of injury and death exists in spite of all reasonable precautions that may be taken. By signing this form for myself, and/or my child, I hereby knowingly and willingly assume all of the risks for myself (and my child), including the risk of injury and even death.

Waiver, Release, Discharge, Indemnity, Hold Harmless and Covenant Not to Sue

I do hereby waive, release and discharge, for myself (and my child) and for all heirs, executors and administrators, any and all rights and claims for damages for personal injury or death suffered by me (us) against the owner, operators, coaches, and other agents of Excel Gymnastics (Releasees) arising from or related to my (child’s) participation in the Activities at Excel Gymnastics; and I hereby, covenant not to sue and agree to indemnify and hold harmless all Releasees from any and all liabilities, claims, demands and causes of action for losses or damages arising from personal injuries or death that may be suffered now or in the future from my or my child’s participation in the Activities.

Video/Photo Release

Participants and/or their parents hereby permit the taking of photos, audio and video while using the facilities or programs at Excel Gymnastics for publications and use as Excel Gymnastics see fit.

Signature

By typing your name below and dating this submission you agree to adhere to all aspects of the Release of Liability Waiver.

Signature*

First Last

Date*

Excel Gymnastics Release of Liability Waiver Form

Acknowledgment and Assumption of Risk

Waiver, Release, Discharge, Indemnity, Hold Harmless and Covenant Not to Sue

Video/Photo Release

Signature