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Athlete Waiver 2022

Acknowledgement, Authorization and Liability Release Agreement

I, the parent/guardian of (child) am acknowledging participation in activities offered and sanctioned by Power Force Athletics Inc. including, but not limited to all areas of cheerleading, tumbling, gymnastics, trampoline, training and/or competition. I am fully aware that activity involving motion, height or athletic activity creates the possibility of serious injury/including death. I release Power Force Athletics Inc., including its owner, agents, officers, directors, shareholders, instructors, and employees from any liability to the above named athlete. I release Power Force Athletics Inc. from liability from an injury arising to the above named athlete on property occupied by Power Force Athletics Inc., including any event sanctioned or sponsored by Power Force Athletics Inc., and/or travel to and from the previous mentioned activities. This release includes but is not limited to any claims of negligence, dangerous conditions, latent defect, premises liability, code violation, vicarious liability, negligent supervision/ maintenance, and/or dangerous equipment; this is intended to be as broad as permissible under Illinois State law. I am fully aware of the nature of the activities provided and the possibility of injuries arising from such activities. I further hold harmless, indemnify and defend Power Force Athletics Inc., including its owner, agents, officers, directors, shareholders, instructors, and employees from any loss, liability, damage, or cost incurred by them due to the above named athlete on the premises occupied by Power Force Athletics Inc. In addition, I give Power Force Athletics Inc. the permission to film, photograph, or videotape the above mentioned athlete for any reproductions, movies, televised events, or promotional print associated or in any way connected with Power Force Athletics Inc. I have read all forms and agree to all terms as stated in each form. I attest that all information given is to the best of my knowledge, factual. I certify that the above-mentioned athlete is in good health and may participate in activities with Power Force Athletics Inc. In case of an emergency where the parents cannot be reached, I authorize Power Force Athletics to secure medical care for the above- mentioned athlete. I further agree to hold harmless the owner and operator of the real estate where such training will occur from any obvious defects in the premises, including by not limited to parking areas, common areas, and walk ways. I understand all terms of this membership contract.

COVID-19 Liability Release Waiver

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which Power Force Athletics (the "Organization") adheres to comply.

In consideration of my or my child’s participation in the foregoing, the undersigned acknowledge and agree to the following:

I Agree
I am aware of the existence of the risk on my or my child’s physical appearance to the venue and my or my child’s participation to the activity of the Organization that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death. Neither have I, nor has my child experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.

I Agree
I have not, nor any member(s) of my household, including the child whose name appears below, traveled by sea or by air, internationally within the past 30 days.

I Agree
I did not, nor any member of my household, including the child whose name appears below, visit any area within the United States that was reported to be highly affected by COVID-19, in the last 30 days .

I Agree
I have not been, nor any member(s) of my household, including the child whose name appears below, diagnosed to be infected of COVID-19 virus within the last 30 days. • Following the pronouncements above I hereby declare the following:

I Agree
I am fully and personally responsible for my own and my child’s safety and actions while and during may participation and I recognize that I or my child may be in any case be at risk of contracting COVID-19.

I Agree
With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me or my child related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19 .

I Agree
I agree on my behalf and my child’s behalf to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.

I Agree
By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; and further that I am the parent and legal guardian of the below named child: That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation. This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.

Date: October 3, 2022 

First Athletes's Name

First Name*

Last Name*
First Athletes's Date of Birth*
I certify that I am 18 years of age or older
First Athletes's Signature*
Second Athletes's Name

First Name*

Last Name*
Second Athletes's Date of Birth*
Third Athletes's Name

First Name*

Last Name*
Third Athletes's Date of Birth*
Fourth Athletes's Name

First Name*

Last Name*
Fourth Athletes's Date of Birth*
Fifth Athletes's Name

First Name*

Last Name*
Fifth Athletes's Date of Birth*
Sixth Athletes's Name

First Name*

Last Name*
Sixth Athletes's Date of Birth*
Seventh Athletes's Name

First Name*

Last Name*
Seventh Athletes's Date of Birth*
Eighth Athletes's Name

First Name*

Last Name*
Eighth Athletes's Date of Birth*
Ninth Athletes's Name

First Name*

Last Name*
Ninth Athletes's Date of Birth*
Tenth Athletes's Name

First Name*

Last Name*
Tenth Athletes's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Insurance Information

Insurance Carrier:

Policy Number:

Primary Carrier:

Relationship to the athlete:
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 Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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