“THE CONFIDENCE BUILDING GYM”
HIGH ENERGY GYMNASTIX ❖ 636.532.7762 ❖ hinrggymnastix.com
140 LONG ROAD, CHESTERFIELD MO, 63005 ❖ 1676 HIGHWAY K, O'FALLON MO, 63366 ❖ 9930 HIGHWAY N, O'FALLON MO, 63367 ❖ 54 THE LEGENDS PARKWAY, EUREKA MO, 63025
Synder Insurance Services, Inc.
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
In consideration of participating in the High Energy Fitness LTD dba High Energy Gymnastics (Hi-NRG) class or other program, I represent that I understand the nature of this Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the Activity. I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the “releasees” named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation in the Activity.
I hereby release, discharge, and covenant not to sue High Energy Fitness LTD dba High Energy Gymnastics (Hi-NRG), its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the result of such claim.
I further acknowledge, understand, appreciate and agree that my participation may result in possible exposure to and illness from infectious diseases, including, but not limited to, MRSA, Influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation and exposure.
I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.
I give permission to High Energy Fitness LTD dba High Energy Gymnastics (Hi-NRG) to take photos of my child/children for use in marketing/advertising within the establishment including social media, newsletters, posters, and other advertising. I give permission to High Energy Fitness LTD dba High Energy Gymnastics (Hi-NRG) to contact me via text or email
High Energy Fitness LTD dba High Energy Gymnastics (Hi-NRG) gives safety of the student the highest priority, employing competent, trained instructors and using the best equipment and safety aids available. If there should be an accident, we will make EVERY EFFORT to contact the child's parents FIRST. IF WE CANNOT get in touch with you, then we MUST have authorization to secure medical treatment. I hereby authorize High Energy Fitness LTD dba High Energy Gymnastics (Hi-NRG) to secure medical treatment for my child in any emergency which may occur while he/she is under our supervision.
We recommend wearing comfortable, athletic clothing to class. Clothing should be properly fitted to your child and mid sections must be covered. Leotards and shorts for girls are recommended. No jewelry or gum is permitted on the gym floor. If your child has long hair it must be pulled back away from the neck and face for safety. No shoes are allowed on the gym floor. Please note - cheer shoes are permitted for tumbling classes if approved by the coach.
Today's Date: January 19, 2021