Loading...

GAGE Center | Bump City | Dragon Ninja Training

Release and Assumption of Risk Waiver 
Medical Authorization | Image Release

ASSUMPTION OF RISKS AND RELEASE OF LIABILITY

I, the undersigned on my behalf and, if applicable, my child (or "children") named below, hereby acknowledge that I and my child(ren), desire to voluntarily participate in the activities and services provided by The Great American Gymnastic Express, Inc. dba GAGE Center (”RELEASEES”)

In consideration of being permitted to enter the premises, use the facilities, obstacles and equipment and/or observe or participate in any way in The Great American Gymnastic Express, Inc. (dba GAGE Center) programs, events or activities (“Activity”), I, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives, estate, and insurers, agree as follows:

  • ACKNOWLEDGE, agree, and represent that I and/or my children understand the nature of the Activity and that I and/or my children are qualified, in good health, and in proper physical condition to participate in such Activity.  I further certify that I am willing to assume the risk of any medical or physical condition that I and/or my children may have.  I agree and warrant that if, at any time, I believe the conditions to be unsafe, I and/or my children will immediately discontinue further participation in the Activity. 
  • ACKNOWLEDGE that I have read the rules and safety information provided and offered by GAGE governing my and/or my child(ren)’s participation in any activities at the GAGE Center campus.  I understand that the rules have been implemented for the safety of all guests at GAGE Center, including myself and/or my child(ren).  I acknowledge that failure to follow the rules could result in the expulsion of myself and/or my children from the activity and/or the facility. I also state and certify that I have explained the GAGE Center rules and safety regulations to my children, as they have been provided to me. 

I FULLY UNDERSTAND that:

  • Severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, those activities including but not limited to gymnastics, tumbling, trampoline, martial arts, dance, cheerleading, free running, parkour, ninja obstacle course training, rockwall bouldering, fitness bootcamp classes, and inflatables.  While rules and equipment are in place to minimize these risks, I am fully aware these risks of serious injury do exist.  I hereby give my consent for me and/or my children to participate in any and all of the GAGE Center and affiliated entities programs and activities and I ACCEPT ALL RISKS associated with such participation.
  • 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 the 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 and/or my child(ren)’s participation and exposure.
  • While rules and equipment are in place to minimize these risks, I am fully aware these risks of serious injury do exist.  I also realize and understand that such risks and dangers cannot be completely eliminated without compromising the essential value, enjoyment and benefits from the unique experiences and values that GAGE programs and facilities offer and provide.  I am voluntarily participating in the GAGE Programs and Offerings with the knowledge of the danger involved with the RISKS. I hereby give my consent for me and/or my children to participate in any and all of the GAGE Center and affiliated entities programs and activities and I ACCEPT ALL RISKS associated with such participation.
  • These risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the activity, the conditions in which the activity takes place, or THE NEGLIGENCE OF THE RELEASEES; and there may be OTHER RISKS or SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time.  I fully assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my and/or my child(ren)’s participation in the activity.
  • If I and/or my child(ren) are injured, I acknowledge that I or my child(ren) may require medical assistance, which I acknowledge will be at my own expense or the expense of my personal insurer(s).  I hereby represent and affirm that I have adequate and appropriate insurance to provide coverage for such medical expense. I UNDERSTAND AND AGREE THAT GAGE CENTER WILL NOT PAY FOR ANY COST OR EXPENSES INCURRED BY ME IF I AND/OR MY CHILD ARE INJURED. 
  • I understand that this waiver extends to injuries incurred by any member of my family, including myself, my spouse and my child(ren).

I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE The Great American Gymnastic Express, Inc (dba GAGE Center), its affiliates, owners, administrators, directors, agents, officers, managers, partners, members, volunteers, employees, other participants, any sponsor 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.

  • This agreement shall remain in effect as long as and whenever I or my child(ren) participate in any activity at or with GAGE Center.
  • If this agreement is not effective to waive liability on behalf of myself, my child(ren), or any other family member, I further agree to indemnify GAGE Center and any of its affiliates for its liability including all costs, fees and expenses incurred by GAGE Center in connection with such liability

I Agree

AUTHORIZATION OF MEDICAL CARE: 

  • In case of illness or injury, if I cannot be reached, I authorize and desire medical care of my child at the discretion of the attending physician.  I accept responsibility for associated expenses.

​

I Agree

IMAGE RELEASE: 

  • I further grant GAGE Center the right, without reservation or limitation, to videotape, and/or record me and/or my child(ren) on closed circuit television. I further grant GAGE Center the right, without reservation or limitation, to photograph, videotape, and/or record me and/or my child(ren) and to use my or my child(ren)’s name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising and promotional materials.

​

I Agree

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 Agree

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*
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 Legal Guardian's Email Address

Email*

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

First Name*

Last Name*

Emergency Contact's Phone Number*
Please answer the following:
How did you hear about us?*
Current Member?*
No
Yes
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Legal Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Legal Guardian's Age Acknowledgment*
Parent or Legal Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Legal 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.




Powered by  Smartwaiver - TRY IT FREE!