Open Gym / Event Waiver
* If not a current member of All Starz Academy
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Email *
Event *
Your Child's Name (First and Last) *
Gender *
Your Child's Date of Birth *
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DD
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YYYY
Address *
City, State , Zip Code *
Current Phone Number *
Parent/Guardian Name *
Parent/ Guardian Email *
Cell Phone/ Emergency Number (During this activity) *
Medical, Physical or other concerns (if applicable consult staff) *
ASSUMPTION OF RISK, WAIVER OF LIABILITY AND MEDICAL AUTHORIZATION As legal guardian of the child listed above, hereafter, I recognize what potentially severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, including but not limited to gymnastics, tumbling, trampoline, dance, cheerleading, Ninjaz, parties, and special events. Being fully aware of these dangers, I voluntarily consent and ACCEPT ALL RISKS associated with the participation of the aforementioned person participating, as well as myself, in any and all All Starz Academy of Gymnastics, Dance, Cheer and Ninjaz programs and activities including if I as a parent or guardian must enter the gym for any reason. Also, if your child requires an inhaler, I understand I am required to stay with him/her or get a doctor’s release. If any participants are injured (cast, crutches, recent stitches, etc.) they may participate by observation only, unless we have a doctor’s release. IN consideration for allowing me and my child to use these facilities, I, on my behalf of my child and our respective heirs, administrators, executors and successors, hereby COVENANT NOT TO SUE and FOREVER RELEASE All Starz Academy of Gymnastics its officers, directors, shareholders, employees or agents from all liability for any and all damages or injuries suffered by my child while under the instruction, supervision, or control of All Starz Academy of Gymnastics including, without limitation, those damages or injuries resulting from acts of negligence on the part of its officers, directors, shareholders, employees, or agents. Additionally, I hereby agree to individually provide for all possible future medical expenses which may be incurred by me or my child as a result of any injury sustained while participating at or for All Starz Academy . By attending this birthday party listed above, I am granting your permission for my child to be filmed, videotaped, audiotaped or photographed by any means and are granting full use of your likeness, voice, and words without compensation. Also, by entering this facility or engaging in any way with All Starz Academy , you are aware that you agree to fully accept all known and unknown risks, including but not limited to the potential risk of exposure to respiratory illnesses such as the coronavirus (COVID-19).COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in All Starz Academy programs or accessing All Starz Academy facilities could increase the risk of contracting COVID-19. All Starz Academy of Gymnastics, Dance, Cheer and Ninjaz in no way warrants that COVID-19 infection will not occur through participation in All Starz Academy programs of accessing All Starz Academy facilities. I have read and understood this ASSUMPTION OF RISK, WAIVER OF LIABILITY and MEDICAL AUTHORIZATION. I VOLUNTARILY affix my name in agreement. Please Type Your Name As Proof Of Signature and Acceptance of the Terms of this Release Form: *
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