Notice To The Minor Child'S Natural Guardian printable pdf download

WAIVER AND RELEASE OF LIABILITY DISCLAIMER

AND EMERGENCY MEDICAL AUTHORIZATION

2016-2017

NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD

ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF U.S. GOLD

GYMNASTICS AND CHEERLEADING ACADEMY, INC. (“U.S. GOLD”), ITS OWNERS, OFFICERS, AGENTS,

EMPLOYEES OR ASSIGNS USE REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A

CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY

BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED

OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR

RIGHT TO RECOVER FROM U.S. GOLD, ITS OWNERS, OFFICERS, AGENTS, EMPLOYEES OR

ASSIGNS, IN A LAWSUIT OR OTHERWISE, FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO

YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS WHICH ARE A NATURAL

PARTY OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM AND U.S. GOLD,

ITS OWNERS, OFFICERS, AGENTS, EMPLOYEES OR ASSIGNS HAVE THE RIGHT TO REFUSE TO LET

YOUR CHILD PARTICIPATE IN THE ACTIVITY IF YOU DO NOT SIGN THIS FORM.

U.S. GOLD IS NOT RESPONSIBLE FOR ANY INJURY (OR LOSS OF PROPERTY) TO ANY PERSON

WHILE PRACTICING, TAKING CLASS, COMPETING, OR PARTICIPATING IN OPEN GYM, BIRTHDAY

PARTIES, KIDS’ NIGHT OUT, PLAY GROUPS, OR FIELD TRIPS, OR IN ANY OTHER WAY INVOLVED IN

GYMNASTICS, CHEERLEADING, OR PRESCHOOL CLASSES OR TEAMS AT U.S. GOLD FOR ANY

REASON WHATSOEVER, INCLUDING BUT NOT LIMITED TO ORDINARY NEGLIGENCE, INCLUDING

GROSS NEGLIGENCE, ON THE PART OF U.S. GOLD, ITS OWNERS, OFFICERS, AGENTS, EMPLOYEES

OR ASSIGNS.

Minor Child Name: __________________________________________________ Grade ______ male/female

Address________________________________________________________ Home Phone_______________

City___________________________ State_______ ZIP__________ Emergency Phone________________

PART I – WAIVER AND RELEASE OF LIABILITY DISCLAIMER

1. I, ___________________________, as parent/legal guardian of _________________________________ (“Gymnast”)

in consideration of Gymnast’s participation in one or more of the programs at U.S. GOLD hereby release, indemnify.,

defend, hold harmless and covenant not to sue U.S.GOLD, its directors, officers, employees, teachers, coaches, agents

and assigns from any and all present and future claims resulting from ordinary negligence, including but not limited to

gross negligence, on the part of U.S. GOLD, its directors, officers, employees, teachers, coaches, agents and assigns, or

others associated with U.S. GOLD, for property damage, personal injury or wrongful death, arising as a result of or in any

way connected to Gymnast’s engaging in or receiving instruction in gymnastics, cheerleading or any other activity or

activities incidental thereto, whenever, wherever, or however the same may occur. On behalf of Gymnast and myself, I

hereby voluntarily waive any and all claims resulting from ordinary negligence, including but not limited to gross

negligence, both present and future, that may be made by me, my family, estate, heirs or assigns on behalf of the

Gymnast.

2. Further, I am aware that gymnastics and cheerleading are vigorous sporting activities involving height and rotation in a

unique environment and as such they pose a risk of injury. I understand that gymnastics, cheerleading and related

activities always involve certain risks, including but not limited to, death, serious neck and spinal injuries resulting in

complete or partial paralysis, brain damage and serious injury to virtually all bones, joints, muscles and internal organs,

and that the mats, pits and other safety equipment and apparatus provided for Gymnast’s protection, including the active

participation of a coach or teacher who will spot or assist said Gymnast in the performance of certain skills, may be

inadequate to prevent serious injury or death to Gymnast. The risk of harm may be limited by all of the safety equipment

and trained coaches, but never eliminated. I understand that participation in gymnastics, cheerleading and related

activities involves actions incidental to active participation in gymnastics, cheerleading or related activities, including

moving from event to event, conditioning, stretching and other actions which may leave Gymnast vulnerable to the

reckless actions of other participants who may not have complete control over their actions or who may not see other

participants who may not have complete control over their actions or who may not see other participants in the gym.

Notice To The Minor Child'S Natural Guardian

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