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Welcome to Pacific West Gymnastics!

Please complete the waiver below.

Please read through the below, clicking "I Agree" or providing a signature as requested.

In consideration of being allowed to entere into the gym and/or participate in ay part/and or program at Pacific West Gymnastics, the undersigned, on his or her own behalf, and/or on behalf of the participant(s) identified below, acknoledges, appreciates and agrees to the following conditions:

I willingly agree to comply with the stated and customary terms, rules and conditions for participation in any party and/or program at Pacific West Gymnastics.  In addition, if I observe any hazard during my participation, I will bring it to the attention of the nearest staff member immediately.

I Agree

I am aware that there is a risk of injury from the gymnastics equipment, and while particular rules, equipment and personal discipline reduce risk, the risk does exist.  I knowingly and freely assume all such risks, both known and unknown, even if arising from the neglience of other participats.

I Agree

I, for myself, and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby hold harmless Pacific West Gymnastics, their affiliates, officers, members, agents, employees, and other participants and sponoring agences with respect to any and all injury, disability, or loss or damage to person, or property to the fullet extent of the law.

I Agree

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK; AND INDEMNITY AGREEMENT (“AGREEMENT”)

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 or I am unable to safely perform any activity, I will immediately discontinue participation in the activity.

I fully acknowledge, understand, appreciate and agree, 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 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 hereby release, discharge, and covenant not to sue your business, it's administrators, directors, agents, officers, volunteers, employees, contractors, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of the premises on which the activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses, damages, on my account caused or alleged to be caused in whole or in party by the negligence of the RELEASEES or otherwise, including negligent rescue operations and further 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, defend, and hold harmless each of the RELEASEES from any loss, liability, damage, or cost, which any may incur as the result of such a claim.

I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, and I 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. I agree that if any portion of this Agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.

PARENTAL CONSENT

I, hereby covenant and promise that I am the minor’s parent and/or legal guardian, and on behalf of myself and the minor, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I further understand the risk of exposure to injury and/or infectious diseases, for myself and my child, as a participant, spectator at events, classes or our presence at the facility. I hereby release, discharge, covenant not to sue and AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS each of the RELEASEES from all liability, claims, demands, losses or damages on the minor’s or my account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including, but not limited to injury, negligent rescue operations, and/or exposure to infectious diseases and I further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above RELEASEES, I WILL DEFEND, INDEMNIFY, AND HOLD HARMLESS each of the RELEASEES from any litigation expenses, attorney fees, loss liability, damage, or cost which any RELEASEE may incur as the result of any such claim.

SPOTTING WAIVER DUE TO COVID-19

I am aware that while gymnastics and tumbling activities are individual sports, there will be times when incidental contact will occur. I acknowledge Pacific West Gymnastics has implemented several protocols and has taken specific measures to encourage social distancing throughout their various programs. While operating in a social and physical distancing environment, I recognize even with best efforts and intentions, there will be times the children will breach the prescribed (6’) distancing
recommendation.

In addition, the teaching and coaching staff will spot (physically assist) when the circumstances require it. Spotting students and athletes is often necessary in order to teach skills safely, to help students and athletes perform skills correctly, and to prevent injury. I understand and agree that spotting will be part of the learning process at Pacific West Gymnastics and I agree to permit my child’s teacher and/or coach to physically assist my child when needed. Direct assistance will also be provided in the event of an injury.

 

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTRE DOCUMENT.  I HAVE READ AND UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT'S TERMS.

Today's Date:  June 28, 2022

First Participant's Name

First Name*

Last Name*

Phone*
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*
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*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Please answer the questions below regarding the birthday party you are attending.

Birthday Child's First and Last Name *

Date of Birthday Party *
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 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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