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The Core Acro LLC Waiver

I am aware that participating in gymnastic activities, dance, acrobatic tumbling/limbering/flexibility/balancing/aerial arts involves inherent risks and hazards. I freely accept and fully assume all such risks, dangers, and hazards and the possibility of personal injury, property damage, or loss resulting from such risks and hazards.

I voluntarily agree to release The Core Acro LLC, Nikki Stichter, employees, volunteers, contractors, and Acrobatic Arts from any and all liability for any loss, damage, injury or expense that I or my next of kin, successors or dependents may suffer or incur as a result of participation with this event due to any cause whatsoever.

 As the Parent or Guardian of

, if I cannot be contacted, I authorize The Core Acro LLC employees/ Acrobatic Arts/ Nikki Stichter to seek medical services in case of serious injury or illness. I further agree to accept financial responsibility in excess of the benefits allowed by my health plan.

 I understand that Nikki Stichter, The Core Acro LLC employees and/or contractors, and Acrobatic Arts will not assume responsibility for any lost or stolen property, or for any bodily or personal injury consisting of or arising out of any participation in any physical training or athletic activity.

 I hereby grant The Core Acro LLC/ Acrobatic Arts/ Nikki Stichter permission to use my/my child’s likeness in photographs and video. These images may appear in publications, promotional material, internal staff training manuals and on the internet in association with Acrobatic Arts. I understand and agree that these images will become the property of Acrobatic Arts, and I hereby irrevocably authorize Acrobatic Arts to edit, copy, exhibit, publish or distribute these images for any lawful and moral purpose.

I agree to abide by all The Core Acro LLC rules and comply with all instructions or requests given by facility staff.

I have had sufficient time to read this entire document and, should I choose to do so, have consulted with legal counsel prior to signing. I acknowledge that participation in any activities at The Core Acro LLC is purely voluntary and I elect to participate despite the risks and that I may discontinue participation at any time. 


Before participating in any activities at The Core Acro LLC, answer the following:
Do you have any known medical conditions that could affect your ability to safely engage in physical exercise/activities?*
No
Yes
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*
Parent or 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*

Emergency Contact's Relation to Participant
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*

Relationship*

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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