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Parental Release Waiver and Assumption of Risk

I am fully aware that gymnastics presents a risk of serious injury, illness, or death, including losses which may result not only from my minor’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the gymnastics classes, instruction, and/or competition is being conducted, and/or the rules of the gymnastics classes, instruction, and/or competition. I am fully aware of and appreciate the risk and damages that might occur as a result of my minor’s participation in or attendance at gymnastics class, instruction, and /or competition.  Therefore, I hereby voluntarily and willingly assume full and complete responsibility for all losses and damages, including injury, illness, and death, resulting from my minor’s participation in the gymnastics classes, instruction, open gym, birthday parties and/or competition, including, if applicable, transportation to and from any competition or off sight class or instruction. I agree I am financially responsible for any losses and damages resulting from my minor’s participation in the gymnastics classes, instruction, open gym, birthday parties and/or competition.

Nonetheless, I, on my own behalf and of my minor, our heirs, administrators and executors, do hereby release, indemnify and agree to hold harmless, and waive all claims or causes of action, including ordinary negligence, against Premier West, its managers, and any of their employees, teachers, coaches, agents and/or any other person(s) or entities associated with, in any capacity, Premier West from any responsibility or liability for any and all claims, demands, damages, costs, causes of action and expenses (including, without limitation, reasonable attorneys’ fees) arising out of or resulting from my minor’s participation in or involvement with gymnastics classes, instruction, and/or competition, including without limitation, any personal injury, disability or property damages incurred or sustained by me or my minor during or as a result of gymnastics class. I understand that the participants family medical insurance policy must cover any medical costs incurred in case of an accident. I also authorize photos to be taken of me and/or my minor and/or film to be captured, including audio, while on the premises or at any gymnastics competition.  Therefore, I hereby authorize Premier West to use and publish images, photographs, pictures, portraits, and audio, video and/or film footage of me and/or my minor in all forms of media and in all manner for publication including, but not limited to, advertising and marketing campaigns, press releases, periodicals, and website use. I hereby waive any right I may have to review, inspect, edit or approve such publication and I release Premier West from any claims I may have against it for use of such images, photographs, pictures, portraits, and audio, video and/or film footage of me and/or my minor.

I understand that this waiver is intended to be as broad and as inclusive as permitted by the laws of the State of Illinois and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be within the State of Illinois.

I do hereby verify that I fully understand and accept the preceding conditions for permitting my minor to participate in gymnastics classes, instruction, and/or competition.

I Agree

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
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Parent or Guardian Phone Number

Phone number including area code *
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*

Relationship*
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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