Loading...

WELCOME TO

THE TRIPLE THREAT NATION

* For minors release wavivers only need to be completed once until the minor reaches the age of 18. Once a minor reaches the age of 18 a new release waiver will need to be completed. 

 

 

 

 

In consideration for the athlete’s name above participation in the activities provided by Triple Threat Cheerleading & Dance, LLC, including but not limited to all aspects of cheerleading, tumbling, trampoline, dance training and/or competition, I am fully aware that any activity involving motion, height, or athletic activity, creates the possibility of serious injury. I hereby release and discharge all rights and claims against Triple Threat Cheerleading & Dance, LLC, including its officers, shareholders, agents, and employees, from any liability to the above named athlete, of the person claiming through him/her, arising from injury to the person or property of the above named athlete occurring on the premises of Triple Threat Cheerleading & Dance, LLC, including any event sponsored or sanctioned by Triple Threat Cheerleading & Dance, LLC, and/or travel to and from such activities. Triple Threat Cheerleading & Dance, LLC strives to provide a maximum in safety procedures and guidelines, and cannot assume responsibility for any accidents, injury, or illness that may occur. This release includes but is not limited to any claims of negligence, dangerous condition, latent defect, premises liability, code violation, negligent security, failure to warn, vicarious liability, negligent hiring, negligent supervision, negligent maintenance, or improper/dangerous equipment; it is intended to be as broad as permissible under New York State law. I am fully aware of the nature of the activities provided and the possibility of injuries arising from such activities. I further agree to hold harmless, indemnify and defend Triple Threat Cheerleading & Dance, LLC, including its officers, shareholders, agents, and employees, from any loss, liability, damage, or cost incurred by them due to the above named athlete on the premises or during any event sponsored or sanctioned by Triple Threat Cheerleading & Dance, LLC. This release is intended to be binding upon the athlete, his/her heirs, assignees, and successor in interest, and anyone claiming by or through him/her. I certify that the athlete is in good health and may participate in activities at Triple Threat Cheerleading & Dance, LLC. It is the responsibility of the parent/guardian to inform Triple Threat Cheerleading & Dance, LLC of any updates throughout the year. In case of an emergency requiring medical treatment, the undersigned hereby authorizes Triple Threat Cheerleading & Dance, LLC to take the above named athlete to a qualified medical or hospital facility for care and treatment. I also give Triple Threat Cheerleading & Dance, LLC and its representatives consent to administer the necessary emergency care to my child to stabilize and/or improve the current injury or condition that my child may have sustained during activities related to Triple Threat Cheerleading & Dance, LLC instruction, practices, or performances. No prior determination of life threatening emergency or danger of serious permanent injury resulting from treatment need be made under this authorization. I give Triple Threat Cheerleading & Dance, LLC the right and permission to film, photograph, or videotape the above named athlete or myself for any reproductions associated in any way with any Triple Threat Cheerleading & Dance, LLC, in particular, reproduction for use in any form of advertisement for promotional purposes and waive any rights of compensation or ownership thereto. In signing this release, I acknowledge and represent that I have read the foregoing Acknowledgement, Authorization, & Release Form, understand it and sign it voluntarily as my own free act and deed, no oral representations, statement or inducements, apart from the foregoing written agreement have been made; I am at lease eighteen (18) years of age (If minor, parent or person representing himself/herself to be the lawful Guardian must sign), and I am fully competent. In addition, I have read and understood the registration form and agree to all terms as stated above. I also attest that all information is factual. I hereby further agree that this Acknowledgement, Authorization, & Release Form shall be construed in accordance with the laws of the State of New York.

 

First Participant's Name

First Name*

Middle Name

Last Name*

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
Third Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
Fourth Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
Fifth Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
Sixth Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
Seventh Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
Eighth Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
Ninth Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
Tenth Participant's Name

First Name*

Middle Name

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
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*
What activity are you participating in?
Click to customize pull down*
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*

Middle Name

Last Name*

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

Please list any physical/physiological limitations, injuries, or weakness that may affect the athlete's participation and/or performance: *
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.

Agree To This Document



Powered by  Smartwaiver