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IGM Gymnastics Open Gym/Special Event/Birthday Party Release of Liability Waiver

Today’s Date:  November 13, 2019

Important: Due to a strict insurance policy, every participant must have this waiver signed by a parent/guardian.  Children without a waiver unfortunately will not be able to participate in the gym activities.  An adult must accompany any child under the age of 4. If your child requires an inhaler, you are required to stay with him/her or get a doctor’s release. Adults are not allowed on gymnastics floor/equipment unless supervising a child who is under the age of 4.

I

, the parent/guardian of children listed above, give my permission for them participate in open gym, events, birthday parties, and classes conducted at IGM Gymnastics. I understand and accept the potential severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, including but not limited to gymnastics, tumbling, trampoline, dance, cheerleading and parties.  Being fully aware of these dangers, I voluntarily consent to the aforementioned person(s) participating in any and all IGM Gymnastics programs and activities and I ACCEPT ALL RISKS associated with that participation. I, on the behalf of my child(ren) and our respective heirs, administrators, executors and successors, hereby CONVENANT NOT TO SUE and FOREVER RELEASE IGM Gymnastics (International Gymnastics of Minnesota, LLC), its officers, directors, shareholders, employees and agents from all liability for any and all damages or injuries suffered by my child(ren) and/or the guardian supervising my child(ren) while under the instruction, supervision, or control of IGM Gymnastics including, without limitation, those damages or injuries resulting from acts of negligence on the part of its officers, directors, shareholders, employees, or agents.

In case of medical emergency, I understand that my child may be transported to an appropriate medical facility by a local emergency unit for treatment. The child will be treated and transported at the expense of my health insurance and/or myself. I understand that in some medical situations, IGM’s staff will need to contact the local emergency resources prior to notifying the parent, physician, or other adult acting on the child’s behalf.

Media Release: By attending open gym, events, birthday party, or classes at IGM, you are granting your permission for you and your child(ren) to be filmed, videotaped, audio taped or photographed by any means and are granting full use of your child’s likeness, voice and words without compensation.

I have read and understand this ASSUMPTION OF RISK, WAIVER OF LIABILITY and MEDICAL AUTHORIZATION. I have VOLUNTARILY affixed my name in agreement and agree to all terms listed above.

Parent/Guardian's Signature

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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