Champions Westlake & 1826 Release Form
Participant's Name:
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Age:
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Medical Concerns/Allergies:
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Parent Name:
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Email Address:
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2nd Participant:
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Age:
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Emergency Contact During Party
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Mobile Phone Number:
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Parental Authorization/Liability & Release
Please initial each authorization
Consent Waiver - I, the undersigned parent or guardian of the above named student(s), do hereby grant authority to the staff of Champions Westlake and/or Champions 1826 to render a judgement concerning medical assistance in the event of an accident or illness in my absence.
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Liability Waiver - Champions Westlake, Champions 1826, and the Shoppes at Mira Vista, their owners, coaches, staff, and volunteers will not be held liable or accountable for any injuries arising out of participation in any and all classes or activities away from or at the gym.
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Permission To Post Photos - I give Champions Westlake and/or Champions 1826 permission to display photos of my child on promotional materials, the website, or social media for the Champions Westlake Community. I agree that my child's first name may be revealed in the descriptive text/commentary in connection with the image(s). I authorize the use of these images without compensation to me. All images shall remain property of Champions.
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