GVA Medical Waiver Form
2018/19 Grand Valley All Stars Recreation Tumbling & Summer Camp Release Open Gym, All Star Cheer Classes & teams, Birthday PartiesPhoto release, Travel Liability
Permission & Waiver

Grand Valley All Stars Liability Waiver and Release
______ I understand that cheerleading/dance/tumbling/stunting/exercise, like any other situation involving height and movements, involves risk and the chance of catastrophic injury, paralysis, and even death, as well as, other damage and losses associated with participation in a cheerleading/dance/tumbling/stunting/exercise(walking, running, jumping, swimming, field trips and events. This child has no problems that might compromise their safe involvement. I understand that I need to provide medical expenses for my son/daughter and forever release Grand Valley Allstars Glenwood Location 51027 Highway 6 & 24 Glenwood Springs, CO 81601, Christine Dingman and any part of the GVA staff including agents, officers, and board of directors, guest instructors, camp instructors, choreographers, guest speakers’ physical training staff and volunteers for any losses or damages occurring as a result of my son/daughter’s participation in any and all activities with the GVA program. I also understand that any injury that is occurred during practice, performance, competition, fundraisers, field trips, camp participation, travel in the vehicle of GVA staff, parent or volunteer with GVA or any activity GVA is not responsible for any medical bills, attorney fees or restitution. I understand that as the parent I am responsible for all medical bills, attorney fees or any other cost associating with injury, sickness or any type of accident that may happen while my child is in the GVA program or on field trips.
I give permission for an appointed GVA staff member or volunteer in emergency situations give medical care to my child. I give permission for an appointed GVA staff or volunteer to make medical decisions in an emergency situation including decisions of transporting to the emergency room/hospital and making emergency decisions if the parent or emergency contact cannot be reached. I agree to the terms and conditions


I give permission for my child to ride/travel with Christine Dingman and Terri Clair and any appointed individual to transport your child to practices, field trips, GVA events, Competitions in state and out of state, Walks, Hikes, runs and any other occasion that your child may need a ride from another parents, staff member or volunteer. I also understand that if an accident occurs, Christine Dingman, Terri Clair or any other staff member of GVA will not be responsible for any injury occurring in such possible accident. I understand that I am responsible for any medical bills, medical transportation, ER expenses, and I will not hold GVA responsible for any expenses due to medical treatment. I also do not hold GVA responsible for injury or death due to an automobile accident.

I agree to let GVA take photos of my child and I release the photos of my child to be used for promotional purposes on the GVA website or GVA Facebook.

Please sign and date:
I release GVA of all medical expenses during the 2018/19 for my child to participate as an All Star programs with the Grand Valley All Stars program.

Glenwood Springs Mall Release of Liability
Glenwood Springs Mall located at 51027 Highway 6 and 24 Glenwood Springs, CO 81601 is not liable for any injury or any other incident that may occur while your child is on the grounds of Glenwood Springs Mall. I the parent release the Glenwood Springs Mall located at 51027 Highway 6 and 24 from all injury or incident while participating with the Grand Valley Allstars program which is located in the Glenwood Springs Mall in the old Zumies location. Glenwood Springs Mall is not responsible for any medical or attorney fees involving any incident with your child.

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Child's Name *
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Parent Name *
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Parent Cell Phone Number *
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Emergency Contact Number
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Please list who is allowed to pick up your child and phone number *
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I understand the terms and conditions of the GVA waiver contract and I understand the wording written in the waiver contract and promise to abide by all the terms. *
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By entering your full name below means that you agree with the terms and conditions and fully understand what I am reading. I agree to follow by the waiver terms and conditions for the full duration of my child's involvement in any class at the GVA Gym. Please type name below. *
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