Birthday party waivers Form

Birthday Party Waiver

Date of Birthday Party

Day and Time

Birthday Child's Name

Last Name

Your Information

Parent / Guardian Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone

Child's Name

Child's Last Name

Date of Birth

Gender

Child#2

Child's Name

Child's Last Name

Date of Birth

Gender

Child#3

Child's Name

Child's Last Name

Date of Birth

Gender

Child#4

Child's Name

Child's Last Name

Gender

Date of Birth

Medical Concerns

Consent 1:

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.

Consent 2:

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 ENERGYM, LLC., Excel Gymnastics, WSSC, LLC. (Releasees) arising from or related to my (child’s) participation in the Activities at ENERGYM, LLC., Excel Gymnastics, WSSC, LLC.; 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.

Consent 3:

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

Date

First Name

Last Name