Loading...

NeoMotion Academy Waiver of Liability & Media Release

NeoMotion LLC, consisting of its owners, staff, volunteers, partners, representatives, and heirs, herein referred to as "NeoMotion," requires all participants of its programs and extracurricular activities to have an updated waiver on file. Please scroll and complete all sections of this waiver.

I, the undersigned Participant or parent or guardian of Participant, do hereby grant permission for the Participant to engage in the activities of tricking and tumbling classes, open gyms, seminars, summer camps, birthday parties, and special events with or at NeoMotion (herein referred to as "Activities"). I understand that these Activities may involve risk to the participant.

I acknowledge and understand that due to the nature of these Activities, which may include but are not limited to running, jumping, kicking, climbing, inversion and rotation of the body, there is a possibility that the Participant may sustain physical illness or injury (minimal, serious, catastrophic, or fatal) in connection with their participation. Parents and participants must understand that NeoMotion will do everything in its ability and beyond to ensure the safety of all Participants, but that no amount of matting, spotting, training, or coaching excellence can guarantee a completely risk free program.

I acknowledge that I have made any previous and current outstanding health concerns, injuries, or other issues aware in the following fields of this waiver and will alert NeoMotion to any new health concerns, injuries, or other issues that may present as Participant ages. I understand and agree that it is ultimately my responsiblity to ensure that Participant is physically, mentally, and emotionally prepared and able to participate in these Activities.

NeoMotion strongly recommends that Participant obtain a physical examination from a licensed medical care provider before beginning these Activities. I understand that any health concerns, injuries, or other issues that may arise as a failure on my part to seek such a physical examination prior to Participant beginning these Activities will not be at the fault of NeoMotion in their usual, reasonable, and customary business operations.

I further acknowledge that I, on behalf of the Participant, assume the risk of such physical illness or injury to the Participant by their engagement in these Activities, and I further release NeoMotion from any claims for personal illness, condition, or injury that the participant may sustain during participation in the Activities. In the event that the Participant sustains injury, condition, or illness of any severity during participation in these Activities, and I am unable to be reached, I hereby authorize NeoMotion to perform or obtain necessary medical treatment, which may include but is not limited to applying ice, bandages, athletic wrap or tape, administering CPR, summoning professional paramedic or ambulatory services, and hereby hold the NeoMotion harmless in the exercise of this authority.

The participant and I have read and understand the above Medical Treatment Authorization and Liability Release, the assumption of risks, and hereby agree to these terms and conditions. My electronic signature on this document acknowledges that I understand what I am signing and that the Participant is physically, mentally, and emotionally prepared and able to participate in the activities.

NeoMotion frequently takes photographs and videos of class activities and other events to use tastefully for promotional purposes on social media, some of which may be used by NeoMotion for commercial purposes on their website and social media channels. I understand that this media may include photographs, videos, and/or audio recordings of the Participant and I hereby give consent for Participant to appear in this media. I further waive any right to inspect, approve, or claim ownership of any finished products created in connection therewith. I have read and agree to this Media Release.

 

Today's Date: November 21, 2019

First Participants Name

First Name*

Last Name*
First Participants Date of Birth*
First Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
First Participants Signature*
Second Participants Name

First Name*

Last Name*
Second Participants Date of Birth*
Second Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Third Participants Name

First Name*

Last Name*
Third Participants Date of Birth*
Third Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Fourth Participants Name

First Name*

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Fifth Participants Name

First Name*

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Sixth Participants Name

First Name*

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Seventh Participants Name

First Name*

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Eighth Participants Name

First Name*

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Ninth Participants Name

First Name*

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Tenth Participants Name

First Name*

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Participants 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 Guardians Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact Info

Name of trusted family member or guardian (Not immediate parent) *

Relationship to student *

Emergency Contact 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 Guardians Name

First Name*

Last Name*

Relationship*
Parent or Guardians Date of Birth*
Parent or Guardians Info & Main Point of Contact

Primary Phone Number *
Text Alerts? (Schedule updates, studio closings, etc)*
Yes
No

Allergies

Previous injuries
How You Heard About Us*

If referral, by whom?

If birthday party, whose?

Please include any relevant additional info about you or your child.
What would you or your child like to gain most from NeoMotion? (You may check multiple) *
Confidence
Strength
Balance & coordination
A consistent fitness routine
Socialization opportunities
All the above
Parent or Guardians 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