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Waiver must be filled out completely or child will not be able to participate

KIDZONE, INC.   Waiver and Liability Release Form

 In consideration of being allowed to participate in any way at KIDZONE, Inc. athletic/ gymnastic/ sports programs, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

  1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and
     
  2. I knowingly and freely assume all such risks, both known and unknown, even if   arising from the negligence of staff employees, agents, and representatives of KIDZONE, Inc. or others and assume full responsibility for my participation or that of my minor child or ward for whom I am signing for as legal guardian of a minor; and
     
  3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I may remove myself or a minor who I have signed for from participation and bring such to the immediate attention of nearest staff employee; and
     
  4. I, for myself, or my minor child/ward and on behalf of my heirs, assigned, personal representatives and next of kin, herby release and hold harmless KIDZONE, Inc., their officers, staff employees, agents, other participants, sponsoring agencies, sponsors, advertisers, and,  if applicable, owners and lessors of said premise used to conduct the event, (collectively the releasees”), with respect to any and all injury disability, death or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise.
     
  5. This is to certify that I, with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the releasees, and, for myself, any heirs, assigns, and next of kin, I release and  agree to indemnify and hold harmless the releasees from any and all liabilities incident to the involvement or participation of my minor child in these programs as provided above. I agree to this even if injury or death arises from the negligence of the releasees. This release is absolute and to the fullest extent permitted by law. I further certify that I have health insurance coverage on myself, or my minor child/ward, and the coverage will remain in full force and effect during the period I, or my child/ward remains enrolled with KIDZONE, Inc. I understand that the failure of KIDZONE, Inc. to verify this information does not waive my responsibility to comply.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND THE TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS WAIVER, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Date: November 22, 2019

First Participant's Name

First Name*

Last Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
First Participant's Signature*
Second Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
Third Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
Fourth Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
Fifth Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
Sixth Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
Seventh Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
Eighth Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
Ninth Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
Tenth Participant's Name

First Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
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*
Insurance

Insurance Carrier*

Insurance Policy 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 Guardian's Name

First Name*

Last Name*

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

Name of class/activity *

Age: *
Check box for Photo Permission to use photos taken of your child on social media and/or emails.
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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