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2022 Registration Form / Waiver of Liability

Elite Xtreme Gymnastics and Tumbling - Release Form - Assumption of Risk – Waiver of Liability- Medical Authorization

  • I recognize that severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, those activities may include but are not limited to gymnastics, tumbling, and trampoline. In addition, being fully aware of these dangers, I hereby give consent for my child(ren) to participate in all Elite Xtreme Gymnastics and Tumbling programs and activities and I ACCEPT AND ASSUME ALL RISKS associated with this participation and hereby, for myself and on behalf of my child(ren) and our respective heirs and successors, COVENANT NOT TO SUE and forever release and hold harmless Elite Xtreme Gymnastics and Tumbling, it’s owners, employees, contractors and volunteers from and against any and all claims, injuries, damages, losses, or liabilities arising from or related to the participation in activities including claims of negligence.
  • In any event of an accident or emergency I hereby authorize my child(ren) to be transported to a hospital or medical facility for medical treatment and I hold Elite Xtreme Gymnastics and Tumbling and its representatives harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by me or my child(ren) as a result of any injury sustained while participating at or for Elite Xtreme Gymnastics and Tumbling.
  • PHOTO & VIDEO RELEASE: I grant consent for my/minor’s picture to be taken or to be filmed while participating in activities at Elite Xtreme Gymnastics. I authorize Elite Xtreme Gymnastics to use and publish images, photographs, pictures, portraits, and audio, video and/or film footage of me/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 Elite Xtreme Gymnastics 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.
  • I understand that if my child misses classes that I am limited to one makeup class per month.
  • I agree PARENTS / SIBLINGS / GUARDIANS AND ANY OTHER PERSONS ARE NOT ALLOWED ON THE FLOOR / equipment at any time. 
  • I agree TUITION WILL BE CHARGED TO MY CREDIT CARD ON FILE ON THE 1st OF EVERY MONTH, and a $15 late fee will be applied after the 10th if balance has not been paid in full. 
  • I agree that in order TO CANCEL OUR MEMBERSHIP, WRITTEN NOTIFICATION MUST BE SENT VIA EMAIL to Elite Xtreme at least 5 business days prior to the first day of the month. I understand that there are no refunds for tuition or membership fees if cancellation policy is not followed as stated above. 
  • I understand that a one-time $50/CHILD REGISTRATION FEE WILL BE CHARGED TO MY CARD on file at the time of initial registration. If at any time my membership is inactive for 6 months or more, I will be required to pay the registration fee again upon re-enrollment. 

Today's Date: May 28, 2022  

First Athletes Name

First Name*

Middle Name

Last Name*

Phone*
First Athletes Date of Birth*
I certify that I am 18 years of age or older
First Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
First Athletes Signature*
Second Athletes Name

First Name*

Middle Name

Last Name*
Second Athletes Date of Birth*
Second Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Third Athletes Name

First Name*

Middle Name

Last Name*
Third Athletes Date of Birth*
Third Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Fourth Athletes Name

First Name*

Middle Name

Last Name*
Fourth Athletes Date of Birth*
Fourth Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Fifth Athletes Name

First Name*

Middle Name

Last Name*
Fifth Athletes Date of Birth*
Fifth Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Sixth Athletes Name

First Name*

Middle Name

Last Name*
Sixth Athletes Date of Birth*
Sixth Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Seventh Athletes Name

First Name*

Middle Name

Last Name*
Seventh Athletes Date of Birth*
Seventh Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Eighth Athletes Name

First Name*

Middle Name

Last Name*
Eighth Athletes Date of Birth*
Eighth Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Ninth Athletes Name

First Name*

Middle Name

Last Name*
Ninth Athletes Date of Birth*
Ninth Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Tenth Athletes Name

First Name*

Middle Name

Last Name*
Tenth Athletes Date of Birth*
Tenth Athletes Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
HOW TO CANCEL MEMBERSHIP
I understand that in order to cancel my membership that I must...*
I understand that if I neglect to notify Elite of my desire to cancel my membership, that I am still responsible for applicable monthly tuition fees until such time that I cancel, even if I don't show up.*
I understand I will NOT receive a refund for tuition charged to my account after the 1st of the month...even if I have not attended any classes. I understand that my enrollment saves a space in class for my child and that this keeps someone else from taking that spot. *
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*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Are there any special physical, verbal, behavioral or learning needs that we should know about that might impact your child's ability to participate in class? *
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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