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Open Gym - Release of Liability Waiver

Synergy Sportz

4750 Winchester Blvd, #2

Frederick, MD 21703

I hereby give my child permission to attend Synergy Sportz Ltd. open gym. I hereby release all rights and claims for damages that my child or I have at anytime against Synergy Sportz Ltd.. It is hereby agreed that I, my child adopted or otherwise, my heir and executers waive and release all rights and claims for damages that I have at any time against Synergy Sportz Ltd. or its representatives, whether paid or volunteer for any injury or damages in connection with Synergy Sportz Ltd.Open Gym program (gym open to public for play) or any other programs and activities run by Synergy Sportz Ltd.. The risk involved in respect to such a program is fully understood. I hereby give my permission for my child to be taken by an ambulance to a nearby hospital to be treated in case of an emergency.

I Agree

 

I understand that Open Gym is a supervised free play hour and that instruction and/or spotting will not be provided; thus Open Gym participants are not permitted to perform any skills that they are not confident in doing.

I understand that Open Gym participants are not permitted to use the high bars, high beams, or rings.

I understand that Open Gym participants are not permitted to move or adjust any apparatus.

I understand that Open Gym participants are responsible for adhering to Gym Rules posted at each event.

I understand that if my child can not read the posted Gym Rules that I must remain with him/her during Open Gym.

 

 

I, and my child, have read and understand the rules posted above.

I Agree

 

I understand that gymnastics is an inherently risky activity, and that if I do not follow the rules above, as well as the rules posted within the gym, that I could increase my risk of injury.

I Agree

 

First Participant's Name

First Name*

Last Name*

Phone*
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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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 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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