Loading...

RELEASE OF LIABILITY, WAIVER OF CLAIMS
ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT 

By signing this document you will waive certain legal rights, including the right to sue.
PLEASE READ CAREFULLY

 

 

Assumption of Risk:

  • I am aware that the gymnastics, tumbling, cheer, trampoline, parkour and ninja training are activities that involve significant risk including risk of personal injury, death, expense and related loss, including loss of income.  I also understand that the risk cannot be eliminated.  The risk of injury includes minor injuries such as bruises, cuts and scrapes and more serious injuries such as broken bones, dislocation of joints, muscle pulls and ligament/tendon damage.  The risk also includes catastrophic injuries such as temporary or permanent paralysis or even death from landings or falls on back, neck or head.  In exchange for my/my child's participation in classes, training, events and activities, I agree to assume such risks and to release, discharge and agree to indemnify and hold harmless Green Mountain Gymnastics, Inc. d/b/a Green Mountain Training Center ("GMG"), its employees, directors, officers and agents (collectively, the "Released Parties") from any liability, loss or damage, including but not limited to that arising from negligence of any of the Released Parties, which may result to me or any minor child of mine, except where such loss or damage is the result of intentional or reckless conduct of the Released Parties.

Medical Attention:

  • I fully understand that GMG employees are not physicians or medical practitioners of any kind.  I authorize GMG employees to render temporary first aid to myself or my child in the event of an injury or illness.
  • I give my consent to GMG and/or host organization to provide, through a medical staff of choice, customary medical/athletic training attention, transportation and emergency medical services as warranted.  I understand that the costs of all medical attention are my responsibility and not that of GMG.

Signature of Agreements:

  • AS THE LEGAL PARENT OR GUARDIAN, I HAVE READ THIS AGREEMENT AND UNDERSTAND IT. I AM AWARE THAT BY AGREEING TO THE POLICIES ABOVE, I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE, WHICH I OR MY NEXT OF KIN, HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST GMG AND OTHERS. By signing this document, I agree to the above terms and policies of Green Mountain Gymnastics, Inc. DBA Green Mountain Training Center.
  • I hereby consent to and authorize GMG to publish reproduce and use for the purpose of advertising any photograph, video image or audio rcording of my child
  • I understand by signing this agreement, I give my consent and understanding of the policies stated above in addition to all future policy updates and changes, provided that I am provided with notice of any such updates and changes. 

Todays date: August 26, 2019

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*
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 Information

Name:

Phone Number:

Relationship:

Name:

Phone Number:

Relationship:
Medical Information
Do you have any medical concerns (i.e. allergies/conditions, etc...)?*
No
Yes

If yes please list any medical concerns (i.e. allergies/conditions, etc...)
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*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver