Father’s Name
Hm#
___ /___/___ Cell
#___/____/_______ WK #___/___/___
E-mail
___________________________________________________________________
Medical info: Please
circle if your child/children has any problem.
Asthma Heart Epilepsy
Diabetes Orthopedics.
Food
Allergies:____________________________________________________________
_________________________________________________________________________
Permission to Treat
I hereby give my permission to trained
professionals to administer emergency medical treatment to my child
should sickness or accident occur in my absence.
*_______________________________________________Date_____________________
Parent or Legal Guardian Signature required for
participation
Release of Liability and Notification of Risk
As parent/guardian of the above
student. I hereby represent that my child/ward is physically fit to
undertake the gymnastics, trampoline, day camp, and Birthday Party
or other activity at the Great Falls Gymnastics academy (herein
after GFGA). I acknowledge the existence of certain risk in these
activities. These activities like any other athletic activity
involving motion and height, involves a risk of injury. Injuries can
include broken bones, sprains, lacerations, internal injuries,
paralysis, or even death. These are risk that anyone participating
in these activities assumes. My child is assuming these risks by
participating in any of the above activities. To reduce the risks
participants must follow all the GFGA rules. I hereby agree that my
child will follow all GFGA rules and that I will instruct him/her to
do so.
In consideration of the right of my child to
participate in GFGA activities I, as parent/guardian, hereby agree
that I waive and release all rights and claims for injury, damages
and loss that I may have at anytime against GFGA, it’s
representatives, employees and agent’s whether paid or volunteer,
for any loss, injury or damages whatsoever, including, but not
limited to, any claim I may have for loss of medical expense, wage
loss, or any other claim as a result of injuries my child/ward
incurs in connection with my child’s participation in GFGA
activities. This release and the following agreement to indemnify
shall include, but not limited to, any claim arising from injuries
my child may incur as a result of negligence of GFGA, it’s
representatives, employees, and agents, weather paid or volunteer.
In addition to the following, I agree to defend,
indemnify, and hold harmless GFGA, it’s representative, employees,
and agents weather paid or volunteer, from and against any and all
liability for any claim, demands, losses, damages, actions causes of
action or suit of any kind or nature whatsoever, and particularly on
account of all injuries or loss, to either person or property, which
may result directly or indirectly form my child/ward’s
participation in activities at GFGA.
This release and agreement to indemnify is binding
upon heirs, legal representatives, agents and assignees. I
understand that participation is entirely by my own choice. I hereby
agree to individually provide for the possible future medical
expenses incurred by my child/ward as a result of any injury
sustained while participating in any of GFGA’S Programs. This
acknowledgment of risk and waiver, having been read thoroughly and
understood completely, is signed voluntarily as to its content and
intent
