Registration
Open Gym, Games, Pizza will be served
Event:
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Family Information
First Name:* Last Name: *
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Email:* (Emails are kept confidential)
 
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City: * State: * Zip: *
Emergency Contact Info
(Not Contact #1 or #2)
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
Omni Gym Waiver
Omni Elite Athletix
704-684-0100
1426 Babbage Lane, Indian Trail
omnieliteathletix.net
2015 Open Gym Waiver
Release of Liability, Waiver of Liability, Assumption of full responsibility for All risk of
bodily injury, death or damages.
As a parent/ legal guardian
I hereby consent to his/her participation in any or all activities for Open Gym held at the Omni
Elite Athletix ( hereinafter “OEA”) including participation in tumbling, cheerleading, trampoline,
and use of OEA's equipment. I understand these activities with OEA may result in injuries such
as paralysis or even death from various causes, known and unknown, which include but are not
limited to, the heights from the equipment and the body during certain movements, rotation of the
body and movement of the body.
I am fully aware that Open Gym activities are without instruction from OEA coaches, instructors
or employees and my child is engaging in these activities under that understanding and at our
own risk. I am fully aware of the inherent risk involved in tumbling, cheerleading, trampoline and
any and all other activities with OEA, and possibility of injury or death from participating in
these activities.
Acting on my behalf, I agree to waive any and all rights, claims, damages, actions, cause of
action or suit of any kind or nature whatsoever which I have or my child has against OEA or any
agent, employee, representative or acting on their behalf and to indemnify, defend and hold
harmless Angie DeHart and OEA any agent, employee, representative or other person acting on
their behalf , from liability or ordinary negligent conduct which may occur.
Should any part or parts of this agreement be null and void, the balance of the agreement shall
remain valid and maintain its full force and effect.

I've read the above and agree.
 
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