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MEMBER AGREEMENT, ASSUMPTION OF RISK, INDEMNIFICATION AGREEMENT, WAIVER AND RELEASE OF LIABILITY AGREEMENT- Texas

CONCUSSION SAFETY PROTOCOL



Galveston Gymnastics LLC

MEMBER AGREEMENT, ASSUMPTION OF RISK, INDEMNIFICATION AGREEMENT, WAIVER AND RELEASE OF LIABILITY AGREEMENT- Texas

I agree to follow all rules and requirements of Galveston Gymnastics LLC as outlined on their website. I understand that when registering my athlete, the athlete is now affiliated with Galveston Gymnastics LLC. My athlete will not participate in organized Cheer or Gymnastics outside of Galveston Gymnastics LLC. Athletes affiliated with Galveston Gymnastics LLC have access to private coaching and exclusive privileges. I grant Galveston Gymnastics LLC the right to photograph and use images for marketing purposes. I agree to receive emails from Galveston Gymnastics LLC. I understand that Galveston Gymnastics LLC does not offer make up classes. If I choose to remove my athlete from Galveston Gymnastics LLC, I agree to submit written notice via email to Admin@galvestongymnastics.com at least 15 days prior to my next scheduled billing date. I understand that if I do not submit written notice within this time frame, I will be charged for the next month. If performing work for Galveston Gymnastics LLC as an employee or contractor, I agree to provide at least three weeks written notice prior to ending my working relationship - *if involved in Cheer Team or Gymnastics Team, I agree to maintain my working relationship until the completion of the current competition season. 

I. DISCLAIMER

This Waiver and Release is applicable to all athletes, siblings, parents, workers and users of equipment provided by Galveston Gymnastics. *(FOR PURPOSES OF THIS WAIVER AND RELEASE, THE TERM “GYM” INCLUDES ALL EMPLOYEES, AGENTS, REPRESENTATIVES, SERVANTS, ASSIGNS, SUCCESSORS, INSURERS AND SUBSIDIARIES OF GALVESTON GYMNASTICS). If any other agreement is supplemented with this Release, the provisions of this Release will prevail over any clauses in the agreement that are inconsistent with this Release. The undersigned agrees that he/she is also signing this Release on behalf of undersigned’s minor children and users of said equipment. Individual agrees that he/she will disclose to Galveston Gymnastics all potential users of said equipment.

I Agree
 


II. EXPRESS ASSUMPTION OF RISK

The undersigned hereby agrees that he/she is using the equipment provided by Galveston Gymnastics at his/her own risk. The undersigned agrees that he/she is voluntarily participating in all activities related to the activity, operation, or use of the equipment, and assumes all risk of injury, illness, damage or loss that might result, EVEN IF THE RISKS ARISE OUT OF THE NEGLIGENCE OR FAULT OF GALVESTON GYMNASTICS. 

I Agree


III. WAIVER/RELEASE OF LIABILITY

By the execution of this Release, the undersigned agrees that Galveston Gymnastics shall not be liable for any damages arising from personal injuries sustained by the undersigned or any minor children under the undersigned’s custody, care, and control, as a result of any and all activities related to the activity, operation, or use of equipment provided by Galveston Gymnastics. The undersigned assumes full responsibility for any such injuries or damages which may occur, and further agrees that Galveston Gymnastics shall not be liable for any loss or theft of personal property. The undersigned specifically agrees that GALVESTON GYMNASTICS SHALL NOT BE RESPONSIBLE FOR SUCH INJURIES, DAMAGES, LOSS OR THEFT, EVEN IN THE EVENT OF NEGLIGENCE OR FAULT BY GALVESTON GYMNASTICS, whether such negligence is present at the signing of this Release or takes place in the future.

I Agree


IV. LIABILITY TO THIRD PARTIES

The undersigned hereby agrees that he/she will indemnify and hold harmless Galveston Gymnastics for all personal injuries, property damages, or any other damages to any and all third parties, including, but not limited to, siblings, family members, and visitors under the undersigned’s custody, care, and control, as a result of any and all activities related to the activity, operation, or use of equipment provided by Galveston Gymnastics, EVEN IF SUCH DAMAGES ARISE OUT OF THE NEGLIGENCE OR FAULT OF GALVESTON GYMNASTICS.

I Agree


V. ACKNOWLEDGMENT OF WAIVER AND RELEASE

The undersigned states that he/she has had sufficient time to review the Waiver and Release and to ask any questions associated with said Release. The undersigned further states that he/she has carefully read the foregoing Waiver and Release, knows the contents thereof, and has signed this Release as his/her own free act. The undersigned warrants that he/she is aware that he/she may attend, participate, or use equipment from another facility, but has chosen to attend, participate, or use equipment from Galveston Gymnastics with the knowledge that signing this Release is a requirement for participation, and use of said equipment. THE UNDERSIGNED FURTHER WARRANTS THAT HE/SHE IS FULLY AWARE THAT HE/SHE IS WAIVING ANY RIGHT HE/SHE MAY HAVE TO BRING A LEGAL ACTION TO ASSERT A CLAIM AGAINST GALVESTON GYMNASTICS FOR GALVESTON GYMNASTICS NEGLIGENCE. 

I Agree


VI. INDEMNITY AGREEMENT

THE UNDERSIGNED AGREE TO INDEMNIFY, HOLD HARMLESS AND DEFEND GALVESTON GYMNASTICS IN ANY MATTER AND FROM AND AGAINST ALL CLAIMS, DAMAGES, LOSSES, AND EXPENSES, INCLUDING ATTORNEY’S FEES ARISING OUT OF AND/OR RELATING TO THE USE OF ALL EQUIPMENT PROVIDED BY GALVESTON GYMNASTICS INCLUDING BUT NOT LIMITED TO ANY NEGLIGENT, GROSSLY NEGLIGENT AND/OR INTENTIONAL ACT OR OMISSION OF GALVESTON GYMNASTICS.

I Agree

***READ RELEASE BEFORE SIGNING***


Galveston Gymnastics - Concussion Safety Protocol

Galveston Gymnastics is committed to protecting the health of and providing a safe environment for each of its participating athletes. We recognize that gymnastics is a high-risk sport for concussion. To this end, Galveston Gymnastics has adopted the following Concussion Safety Protocol for all athletes. This protocol identifies expectations for the club’s concussion management practices as they relate to (1) the definition of sport-related concussion; (2) preseason education; (3) recognition and diagnosis; (4) post-concussion management; (5) return-to-learn & sport; and (6) limiting exposure to head trauma.

1. Definition of Sport-Related Concussion

The Consensus Statement on Concussion in Sport, which resulted from the 5th international conference on concussion in sport, defines sport-related concussion as follows:


Sport-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilized to clinically define the nature of a concussion head injury include:

• SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.

• SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.

• SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.

• SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.

2. Preseason Education

All athletes and parents of minor athletes will be provided and allowed an opportunity to discuss educational material (e.g., the USA Gymnastics Sports Concussion Overview) and be required to sign an acknowledgement that they have been provided, reviewed and understood the concussion education material.

All coaches involved in athlete health and safety decision making are required to complete concussion education training prior to coaching and annually thereafter. Coaches must be allowed an opportunity to discuss educational material (e.g., the USA Gymnastics Sports Concussion Guidelines, the USA Gymnastics Sports Concussion Overview) and be required to sign an acknowledgement, on an annual basis, that they have been provided, reviewed and understood the concussion education material.

Concussion education should include:

• The definition of concussion

• Possible mechanisms of injury

• Common signs and symptoms

• Steps that can be taken to prevent concussions and other injuries from occurring

in gymnastics

• What to do when an athlete has suffered a suspected concussion or more

serious head injury

• What measures should be taken to ensure proper medical assessment

• Return-to-School and Return-to-Sport Strategies (See USAG return to sport

progression for gymnastics-specific progressions for each discipline)

• Return to sport medical clearance requirements

3. Recognition and Diagnosis of Concussion

I consent Galveston Gymnastics LLC to provide medical care and transport my child(ren) in the case of an emergency. 

All coaches in a member club must be able to recognize the potential mechanism of injury of a concussion and the signs and symptoms of acute concussion. Coaches must immediately discontinue training or competition for anyone who is suspected of having a concussion and must monitor the athlete until a parent arrives. Coaches must be able to recognize red flag signs and symptoms and must activate 911 if these signs and symptoms are present.

Medical personnel with training in the diagnosis, treatment and initial management of acute concussion will be present at all high-risk USAG sanctioned competitions (see Rules & Procedures for definition of high-risk for your discipline).

Any athlete that exhibits signs, symptoms or behaviors consistent with concussion:

• Must be removed from practice or competition until they are evaluated by a medical professional.

• Must be evaluated by a physician (or physician designee) with concussion experience.

• May only return to play the same day if onsite medical personnel determine that concussion is no longer suspected.

4. Post-concussion Management

Activation of emergency action plan must occur for any of the following scenarios following a suspected concussion:

§ Severe or worsening headache

§ Weakness or numbness in the arms or legs

§ Vomiting

§ Slurred speech

§ Neck pain

§ Double vision

§ Seizure activity or convulsions

§ Agitated or combative

§ Loss of consciousness or deteriorating conscious state (going in and out of

consciousness)

Because concussion may evolve or manifest over time, for all suspected or diagnosed concussions, athlete should be monitored by club personnel trained in concussion until a parent arrives. An athlete should never be allowed to drive him/herself home after a suspected concussion.

For all cases of suspected or diagnosed concussion, there must be documentation that post-concussion plan of care was communicated to both the athlete and another adult responsible for the athlete, using the USA Gymnastics Sports Concussion Information form.

 5. Return-to-Learn & Sport


Prior to return to gymnastics after a concussion event, the athlete must be symptom free with all activities of daily living and academic activities. Performance of academic activities must be back to the athlete’s baseline and without modification.

Return-to-sport progressions should not begin until the athlete has completed an unrestricted return-to-learn progression. Initiation of the return-to-sport protocol must be approved by a physician or his/her medically qualified designee.

The timeline for return-to-sport varies based on individuals and other medical conditions including prior history of concussion. It generally takes longer for children and adolescents to return-to-sport than it does for adults.

Final determination of unrestricted return-to-sport will be made by a physician or his/her medically qualified designee following implementation of an individualized, supervised stepwise return-to-sport progression detailed in the USA Gymnastics Gymnastics- Specific Return-to-Sport Strategy document that includes:

1. Rest followed by light aerobic activity.

2. Return to early sport training: Inversion.

3. Progress sport specific training: Flipping.

4. Progress sport specific training: Twisting.

5. Progress sport specific training: Advanced Skills (physician clearance required to

move to step 6).

6. Return to full training.

The above stepwise progression will be supervised by a health care provider with expertise in concussion, with it being typical for each step in the progression to last at least 24 hours.

NOTE: If at any point the athlete experiences a return of concussion-related symptoms, they should go back to the previous stage that they completed symptom-free, wait for symptoms to resolve (minimum 24 hours), and then begin the progression again. The minor athlete’s parent should always be notified if the athlete becomes symptomatic.

7. Limiting Exposure to Head Trauma

Galveston Gymnastics is committed to protecting the health of and providing a safe environment for each of its participating athletes. We will provide a safe environment for our athletes by:

1. Ensuring gymnasts have completed proper progressions prior to trying a new skill. 2. Using proper mats and equipment setup.

3. Having spotters in place at practice and during competition.

4. Ensuring the area is clear prior to beginning a skill to prevent collisions.

5. Ensuring equipment is properly maintained and inspected.

  

By signing and dating this form, I hereby acknowledge, that I will adhere to the club’s Concussion Safety Protocol.



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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.


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