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WAIVER & RELEASE FORM

WARNING! CATASTROPHIC INJURY, PARALYSIS OR EVEN DEATH CAN RESULT FROM THE IMPROPER CONDUCT OF THE ACTIVITY
In consideration of Northfield Gymnastics Club (NGC) accepting myself or my child to participation and/ or training in gymnastics, which activity I hereby acknowledge involves greater than normal risk of injury, I agree, for myself or as my child’s parent/guardian to assume responsibility of all risks, cost, or losses sustained by me, my child , or my child’s family in connection with participation in gymnastics classes, programs, lessons, meets, birthday parties, open gym, field trip, CAMP OR any other activities connected with Northfield Gymnastics Club. I give my permission to NGC and/or appropriate medical facility to make whatever emergency (first aid, disaster evacuation, etc..) measures as judged necessary for the care and protection of myself or my child while under the supervision of NGC. In case of an emergency, I understand that I or my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency resources deem it necessary. Transportation will be at my own expense. It is under stood that in some medical situations, the staff will need to contact the local emergency resource before the parent, physician and/or other acting on behalf of the parent or family can be reached. Further, I hereby verify by my signature below, that I fully understand and accept each of the above conditions for participation or for permitting my child to participate in activities at NGC.

I hereby release and hold harmless NGC, sponsors, coaches, students, volunteers, officers, officials, directors, employees, advertisers, representatives and agents of any of the above with respect to any and all illness, disability, death, loss or damage to person or property, whether arising from negligence of releasees or otherwise to the fullest extent permitted by lawI certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any supervisor, coach or other team administrator associated with the Northfield Gymnastics to seek and give appropriate medical attention for our child(ren) in the event of an accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment.

I hereby waive, release and forever discharge Northfield Gymnastics from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Northfield Gymnastics activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my children is (are) physically fit and capable of participation in all activities.

Consent to photograph and Media Release: I understand that my child’s photograph or video may be taken during the course of class instruction during a special event at Northfield Gymnastics Club or at a function sanctioned by NGC. I hereby grant permission to promotional publications. (e.g. website, NGC facebook page, newspaper ads, bulletin boards, newsletters, programs, brochures, public broadcasting releases, etc.) and to allow the news media to film and/or photograph programs and activities for broadcast purposes.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone 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*

Middle 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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