Loading...

JERSEY JETS GYMNASTICS, INC. LIABILITY, RELEASE and INJURY WARNING

IMPORTANT READ, UNDERSTAND THE FOLLOWING BEFORE SIGNING

RISK OF INJURY WARNING

In consideration of your child’s participation in activities at Jersey Jets Gymnastics, Inc: I state that I understand the nature of this activity and that the student(s) are qualified, in good health, and in proper physical condition to participate in this activity. I also acknowledge that if current conditions change and become unsafe I will immediately discontinue the participation of my child in the activity. Jersey Jets Gymnastics, Inc. is warning that GYMNASTICS AND TUMBLING HAS A RISK OF PHYSICAL INJURY THAT CANNOT BE ELIMINATED. Included are minor injuries and more serious such as broken bones and dislocations. The risk also includes catastrophic injuries such as permanent paralysis or even death from landing or falling onto the back, neck or head. I further understand that there are other risks either not known to me, or unforeseeable at this time. I fully accept and assume all responsibility for injuries, loss, damages, and costs incurred as a result of participation in this activity. 

RELEASE INFORMATION

As a participant or legally responsible person for the students(s) listed above, I recognize the serious risk in gymnastics and tumbling. I assume all responsibility for the student(s) listed above and release Jersey Jets Gymnastics, Inc. and all employees from losses resulting from participation in activities sponsored by Jersey Jets Gymnastics, Inc. This also certifies that the students(s) are physically able to participate in vigorous physical activity and competitive sport. 

SAFETY INFORMATION

All students must be picked up promptly at the end of class. If children are required to wait for your arrival they must not leave the building. Please plan to stay with young children during their class. If you do need to leave your child during their class make sure they know and that the desk has your cell phone number and are aware you will be gone. If you will be late for pick up of your child please make sure to call the gym so we can inform your child, and tell them they should wait in the lobby until you arrive. (856) 273-2822.

 

I hereby release and agree to hold Jersey Jets Gymnastics, INC. harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the facility, or that may otherwise arise in any way in connection with any services received from Jersey Jets Gymnastics, INC in accords to the Coronavirius/COVID-19 pandemic. I understand that this release discharges Jersey Jets Gymnastics, INC. from any liability or claim that I, my heirs, or any personal representatives may have against the facility with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Jersey Jets Gymnastics, INC. This liability waiver and release extends to the facility together with all owners and employees.

 

 


Date: January 29, 2023

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Medical Information

Asthma, allergies, previous injuries, etc.
First Participant's Signature*
Second Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
Third Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
Fourth Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
Fifth Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
Sixth Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
Seventh Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
Eighth Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
Ninth Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
Tenth Participant's Name

First Name*

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

Asthma, allergies, previous injuries, etc.
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
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Photo Release
Parent Contact Information

First and Last Name *

Phone Number *

Cell Phone Carrier *

Relationship to participant *
Secondary Contact Information

First and Last Name *

Phone Number *

Email Address *

Relationship to Student *
Medical Insurance: (Medical insurance is required for participation.)

Medical Insurance Carrier: *
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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 Medical Information

Asthma, allergies, previous injuries, etc.
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 - TRY IT FREE!