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USAG WAIVER AND RELEASE OF LIABILITY, TRANSPORTATION AND MEDICAL RELEASE WAIVER All Team Members must complete Release Waivers and submit along with Team Contracts. PLEASE COMPLETE ALL QUESTIONS AND AGREEMENT ITEMS
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
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Aunt/Uncle
Brother
Father
Grandparent
Guardian
Mother
Nanny
Other
Owner/Director
Parent
Sister
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $30.00 :
Desired Start Date for classes:
*
Notes :
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $30.00 :
Desired Start Date for classes:
*
Notes :
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $30.00 :
Desired Start Date for classes:
*
Notes :
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $30.00 :
Desired Start Date for classes:
*
Notes :
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $30.00 :
Desired Start Date for classes:
*
Notes :
Questions/Options:
Full Name of Athlete
*
Relationship to gymnast
*
Emergency contact Full Name
*
Emergency contact Phone #
*
Insurance Carrier
*
Policy Number
*
Name of person holding the policy
*
Address of person holding the policy
*
Home Phone
*
Cell Phone
*
Work Phone
*
Relationship to gymnast
*
Today's Date
*
Additional Information:
WAIVER AND RELEASE OF LIABILITY
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DISCLAIMER: REBOUNDERS GYMNASTICS IS NOT RESPONSIBLE FOR ANY INJURY OR LOSS OF PROPERTY TO ANY PERSON WHILE PRACTICING, TAKING CLASS, COMPETING, PARTICIPATING IN OPEN GYM, OR IN ANY OTHER WAY INVOLVED IN GYMNASTICS AT REBOUNDERS GYMNASTICS FOR ANY REASON WHATSOEVER, INCLUDING ORDINARY NEGLIGENCE ON THE PART OF REBOUNDERS GYMNASTICS, ITS OWNERS, OFFICERS, AGENTS, OR EMPLOYEES.
In consideration of my child’s participation, I hereby release and covenant not-to-sue Rebounders Gymnastics ,Inc. and any of their owners, officers, employees, teachers, coaches, or agents, from any and all present and future claims resulting from ordinary negligence on the part of Rebounders Gymnastics, Inc. or others listed for property damage, personal injury, or wrongful death, arising as a result of my child engaging in or receiving instruction in gymnastics, or any other activities or any activities incidental thereto, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future, that may be made by me, my family, estate, heirs, or assigns.
I agree to indemnify and hold harmless Rebounders Gymnastics and all others listed for any and all claims arising as a result of my child engaging in or receiving instruction in Rebounders Gymnastics, Inc. activities or any activities incidental thereto whenever, wherever, or however the same may occur.
I am aware that gymnastics is a vigorous activity involving height and rotation in a unique environment. This includes the active participation of a coach or teacher who will spot or assist in the performance of certain skills. The risk of harm may be limited by all of the safety equipment and trained coaches, but never eliminated. I am voluntarily allow my child to participate in this activity with the knowledge of the risks involved and hereby agree to accept any and all inherent risks of property damage, personal injury, or death.
I understand that this waiver is intended to be as broad and as inclusive as permitted by the law of the state of Maryland and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be within the state of Maryland.
I affirm that I am of legal age and am freely signing this agreement. I have read this form and fully understand that by signing this form, I am giving up legal rights and or remedies which may be available to me for the ordinary negligence of Rebounders Gymnastics, Inc. or any person listed above.
I've read the above and agree.
TRANSPORTATION AND MEDICAL RELEASE WAIVER
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In consideration for my membership on the Rebounders Gymnastics Team, I agree to be bound by each of the following:
TRANSPORTATION WAIVER AND RELEASE: I hereby give permission to Rebounders Gymnastics for my child to travel and be transported to and from provided activities in the vehicle provided and agree not to hold Rebounders Gymnastics, Inc., its directors, officers, agents or employees liable for any accident or injury suffered or contracted in connection with such travel.
MEDICAL ATTENTION: I hereby give my consent for Rebounders Gymnastics to provide, through a medical staff of its choice, customary medical/athletic training attentions, transportation, and emergency medical services (excludes major surgical procedures, unless necessary to save the individual’s life) as warranted in the course of my child’s participation in Rebounders Gymnastics, Inc. activities. I further authorize the above designated to execute that consent required in connection with such advice or treatment. I hereby release said persons from and agree to indemnify them against any liability arising out of the exercise of the authority here granted. I consent to the release of a report containing diagnosis and other medical information related to the examination and treatment of my child to agencies and companies, as might be considered with payment of charges for services.
I understand that I am responsible to provide updated emergency contact information.
I've read the above and agree.
Video/Photographic/Website Release
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I, hereby give Rebounders Gymnastics, Inc. my permission to use photography and or video clips of my child for the purpose of advertising, brochures, Rebounders web site, television broadcasting, and/or use of any video or photographic materials for any lawful purpose.
I've read the above and agree.
Agreement Signature
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With my signature below, in consideration for my child's membership on the Rebounders Gymnastics Team, I agree to all items in the Release of Liability, Transportation, and medical waivers.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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