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Registration/Liability Waiver

ASSUMPTION OF RISK ● WAIVER OF LIABILITY ● PHOTO RELEASE ● MEDICAL AUTHORIZATION

I recognize that students may suffer injuries, possibly minor, serious or catastrophic in nature in sports or activities involving height or motion, those activities including but not limited to gymnastics, tumbling, trampoline, and dance. Being fully aware of these dangers, I hereby give consent for my child (ren) to participate in any and all Rising Starz Fitness, Inc. programs and activities and I ACCEPT ALL RISKS associated with this participation.

In consideration for my child (ren)’s participation I hereby, for myself and my child (ren) and our respective heirs and successors, PROMISE NOT TO SUE and FOREVER RELEASE Rising Starz Fitness, Inc. its officers, directors, shareholders, employees, contractors, volunteers, and leasers of premises on which the activity takes place from all liability resulting in damages or injuries incurred as a result of participation.

I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for me or my child (ren)‘s participation I hereby grant my permission for my child’s likeness to be used in Rising Starz Fitness publicity or advertising.

I fully understand that Rising Starz Fitness’s staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the Rising Starz Fitness staff to render temporary first aid to my child or child (ren) in the event of any injury or illness. I hereby give my permission for trained medical professionals to administer emergency medical treatment to my child (ren) should sickness or an accident occur in my absence. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by myself or my child(ren) as a result of any injury sustained while participating in Rising Starz Fitness Program.

I have read and understand this ASSUMPTION OF RISK and WAIVER OF LIABILITY and PHOTO RELEASE and MEDICAL AUTHORIZATION and I VOLUNTARILY affix my name in agreement.

 

 

 

Please select who will be participating at Rising Starz Gymnastics and Fitness
Minor(s)
1 Minor2 Minors3 Minors4 Minors5 MinorsMore Minors6 Minors7 Minors8 Minors9 Minors10 Minors
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Any medical conditions we need to be aware of:
First Participant's Signature*
Second Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
Third Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
Fourth Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
Fifth Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
Sixth Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
Seventh Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
Eighth Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
Ninth Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
Tenth Participant's Name

First Name*

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

Any medical conditions we need to be aware of:
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Any medical conditions we need to be aware of:
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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