Royal City Cheer Tumbling Parkour Liability Waiver Form
TO BE COMPLETED BY PARENT/LEGAL GUARDIAN ONLY for minors, OR IF OF 18 YRS OR OLDER, MAY COMPLETE FOR SELF.
Royal City Cheer and Tumbling Society
102-100 Braid St, New Westminster BC 604.600.5111
www.royalcitycheer.com
Assumption of Risk, Release of Liability, Waiver of Claims and Indemnity Agreement
WARNING: by signing, (the “agreement”) you will waiver certain legal rights, including the right to sue.
Please read carefully.
All sections must be completed in order to participate.
Incomplete waivers, or those with errors will not be accepted and will prevent participation.
Email address *
Release:
By accepting below, 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 initialing 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.
Assumption of Risks: I understand that by participating in the classes, programs, workshops, “open gym” sessions, events or parties, offered by Royal City Cheer and Tumbling Society (RC), I will receive information and instruction about various physical programming, and i recognize that acting on this information or instruction will require the use of RC’s equipment and facilities.
I further understand and am aware of the risks, dangers and hazards associated with or arising from the use of the equipment and facilities of RC and from participation in the activities, including but not limited to: fainting, abnormal blood pressure, musculoskeletal injuries (such as neck and back strains, muscle strains, pulls, tendon and ligament damage, damage to the joints of bones fractures_, paralysis, death, or damage to myself property or to third parties, resulting from”
a) falling and impacting wall surfaces or the ground, including any fixed or mobile objects, or equipment, including both wooden and metal objects, obstacles or equipment;
b) Falling participants or equipments
c) Participation in the physical activity of the sport itself;
d) negligence on the part of other participants and or
e) negligence on the part of RC, its employees, agents, instructors, independent contractors, volunteers (collectively the “Releasees”), including the failure on the part of the Releasees to safeguard or protect the participant or visiting party from the risks, dangers and hazards of the activities.
Release of Liability, Waiver of Claims and Indemnification: In consideration for RC allowing me / my child to participate in the activities and permitting my use of RC equipment and facilities, and for good and valuable consideration, the receipt and sufficiency of which is acknowledged i agree as follows:
1. to waiver any and all claims that i have or may in the future have against the Releasees and to release the Releasees from any and all liability for any loss, damage, expense, or injury including death that i or my child may suffer, or that my next of kin may suffer resulting form my participation in the activities due to any cause whatsoever, including negligence, breach of contract, or breach of any statutory or other duty of care, including any duty of care owed under the Occupiers Liability Act, RSBC. 1996, C. 337, on the part of the Releasees, and also including the failure on the part of the Releasees to safeguard or protect me / my child from risks, dangers and hazards.
2.To hold harmless and indemnify the Releasees from any and all liability for any damage to property of or personal injury to any third party, resulting from my / my child’s participation in the activities.
3. This agreement shall be effective and binding upon my heirs, next of kind, executors, administrators, and representatives, in the even of my / my child’s death or incapacity.
4. This agreement limits the liability of RC employees, agents, instructors, or independent contractors (the “Agents”) to the same extent as it limits the liablity of RC, even though the Agents are not formally parties to the Agreement;
5. In entering into this agreement, I am not relying upon any oral or written representations or statements made by the Releasees with respect to the safety of the activities other than what is set forth i this agreement
6. This agreement supersedes any prior agreement or understanding between the parties
7. This agreement and any rights, duties and obligations as between the parties to this agreement shall be governed by and interpreted solely in accordance with the laws of the province of British Columbia and no other jurisdictions; and
8. Any litigation involving the parties to this agreement shall be brought solely within the province of British Columbia and shall be within the exclusive jurisdiction of the courts of the province on British Columbia.
I consent and authorize RC, its employees, agents, instructors or independent contractors to take still pictures, motion pictures, sound recordings, and /or video recordings of the participant and to use and adapt such materials in its educational and recreational programs and/or in promoting RC programs or activities at any time or place and in any medium in the future. I agree to indemnify, hold harmless, and release RC and its agents, from any and all claims arising from such material.
Assumption of Risks: Release of Liability, Waiver of Claims and Indemnification: *
Required
MAIN PROGRAM(S) OF PARTICIPATION *
Required
PARENT INFORMATION
If you are the participant and are 19 years or older, please complete the parent section with your own information as well as the participant #1 section.
Parent / Legal Guardian Name: *
Your answer
Parent / Legal Guardian Phone Number: *
Your answer
PARTICIPANT INFORMATION
Participant #1 Name: *
Your answer
Participant #1 Relationship to Guardian: *
Your answer
Participant #1 Date of Birth *
MM
/
DD
/
YYYY
Participant #2 Name:
Your answer
Participant #2 Relationship to Guardian:
Your answer
Participant #2 Date of Birth
MM
/
DD
/
YYYY
Participant #3 Name:
Your answer
Participant #3 Relationship to Guardian:
Your answer
Participant #3 Date of Birth
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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