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CLT Management Inc.
DBA Gigueres
Waiver

Birthday Parties, Field Trips, Open Gyms

CLT Management encompasses Gigueres, Gigueres Dance, and Gigueres Trampoline. For this waiver, the use of the word Gigueres will represent all businesses under CLT Management Inc.

 

CLT Management, Inc. dba Gigueres Acknowledgment and Assumption of Risk:

I request for myself, and/or any of my children to participate in gymnastics, day care or nursery school, dance, trampolining, kung fu or any other activity at Gigueres and to receive instruction in such subjects from Gigueres' staff and associates.  I understand that such participation and instruction require the performance of physical exercises by my myself and/or my child which necessarily involves the risk of personal injury, including severe paralysis or even death to myself and/or my child. Neither my child nor myself are under compulsion by Gigueres, its officers, teachers, employees and associates to participate in this program nor am I being paid to do so.  My interest and/or my child's interest is solely in the activities at Gigueres and his/her self-improvement and I willingly accept the risk inherent in this pursuit.  In consideration for allowing myself and/or my child to use these facilities, I hereby forever release Gigueres, its officers, employees, teachers and associates from all liability for any and all damages and injuries suffered by myself and/or my child in connection with said use of these facilities.  This acknowledgment of risk and waiver, having been read thoroughly and understood completely is signed voluntarily as to its content and intent. 

I represent and warrant that if I am purchasing something or paying for a service from this facility or from other merchants through this facility that (i) any credit card or bank account draft (ACH Draft) information I supply is true and complete, (ii) charges incurred by me will be honored by my credit card company or financial institution, and (iii) I will pay the charges incurred by me at the posted prices, including any applicable taxes, fees, and penalties. 

I hereby authorize (if online payment is made or autopay information is provided) this facility to charge my ACH draft, or credit card account. I understand that a 30 day written notice is required to terminate billing and I am responsible for payment whether or not my student attends classes until I notify this facility in writing to drop my student from class(es). 

Should I dispute a charge through my financial institution this will constitute a breach of contract possibly resulting in, but not limited to, penalties, additional fees, collection, legal action, and/or termination of any and/or all current and future services. 

I Agree

 

 

Date: September 19, 2018

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*
Parent or Guardian's Email Address

Email*

Confirm Email*
Photo Release
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) participation, I hereby grant my permission for my child(ren) likeness to be used in Gigueres publicity or advertising.*
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*
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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