Gleason'S Waiver & Release Form printable pdf download

GLEASON’S WAIVER & RELEASE FORM

Participants Name__________________________________ Birthdate____/____/________

Participants Name__________________________________ Birthdate ____/____/________

Activity: __Class __Birthday Party __Open Gym __Field Trip __Other_______________

Parent Name ________________________________ Phone # _________________________

(if applicable)

Address ____________________________City____________ State_____ Zip Code________

Emergency Contact____________________Relationship__________Phone______________

Waiver and Release

WARNING! CATASTROPHIC INJURY, PARALYSIS OR EVEN DEATH CAN RESULT FROM

THE IMPROPER CONDUCT OF THE ACTIVITY

In consideration of Gleason’s Gymnastic School accepting myself or my child into participation

and/or training in gymnastics, which activity I hereby acknowledge involves greater than normal

risk of injury, I agree, for myself or as my child’s parent/guardian to assume responsibility for all

risks, cost, or losses sustained by me, my child, or my child’s family in connection with

participation in gymnastics classes, programs, lessons, meets, birthday parties, open gyms, field

trips or any other activities connected with Gleason’s.

I give my permission to Gleason’s Gymnastic School and/or appropriate medical facility to make

whatever emergency (first aid, disaster evacuation, etc.) measures as judged necessary for the

care and protection of my self or my child while under the supervision of Gleason’s Gymnastic

School.

In case of an emergency, I understand that I or my child will be transported to an appropriate

medical facility by the local emergency unit for treatment if the local emergency resources deem it

necessary. Transportation will be at my own expense.

It is understood that in some medical situations, the staff will need to contact the local

emergency resource before the parent, physician and/or other acting on behalf of the parent or

family can be reached.

Further, I hereby release and agree to hold harmless and to indemnify Gleason’s Gymnastic

School employees, owners or volunteers from any claims, losses or expenses incurred or on the

behalf of me, my child or my child’s family.

Speaking for myself or as a legal guardian of this participant, I hereby verify by my signature

below, that I fully understand and accept each of the above conditions for participating or for

permitting my child to participate in activities at Gleason’s Gymnastic School.

Consent to Photograph and Media Release: I understand that my child’s photograph or video

may be taken during the course of class instruction, during a special event at Gleason’s

Gymnastic School or at a function sanctioned by Gleason’s.

I hereby grant permission to

Gleason’s Gymnastic School to use my child’s photograph or likeness in any publicity or

promotional publications. (e.g., web site, newspaper ads, bulletin boards, newsletters, programs,

brochures, public broadcasting releases, etc.) and to allow the news media to film and/or

photograph programs and activities for broadcast purposes.

Participant Signature__________________________________________Date_____________

If participant is 18 years or older

Parent/Guardian Signature_____________________________________Date_____________

If participant is under 18 years of age

Email address_______________________________________ Gleasons will neither sell nor

share you email address. Email addresses will be used for communication purposes only.

Gleason'S Waiver & Release Form

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