EmailMe Form - Special Event Release Form

Image

Date of event *

MM / DD / YYYY

Name of child participant *

First Last

Attention:

Date of Birth *

MM / DD / YYYY

Gender *

Male

Female

Medical Condition - If yes, please explain.

Medical Condition continued

2nd Name of child participant, if applicable

First Last

Date of Birth

MM / DD / YYYY

Gender

Male

Female

Medical Condition - If yes, please explain.

Medical Condition continued

Parent/Guardian Information - Please fill out form completely.

Parent Name or Legal Guardian *

First Last

Phone *

### - ### - ####

Address *

Street Address City State / Province / Region Postal / Zip Code

Email *

Emergency Phone *

### - ### - ####

Emergency Contact Name *

First Last

May we use your child's photo on our website or in advertisements? No names will be disclosed. *

Yes

No

Universal Gymnasts, Inc. - Liability Release

In consideration of the permission granted my child to participate in a Universal Gymnasts, Inc. sports activity, class, birthday parties, competition, team, including non-gymnastics activities such as swimming and playground activities (hereinafter referred to as the "Activity"), I, the parent or legal guardian of the above named child, make the following representations:

(1) I understand the nature of the Activity that my child will participate in, and I represent that, to the best of my knowledge, my child is qualified, in good health, and in proper physical condition to participate in the Activity. I further represent and acknowledge that, should I ever believe that any of the above representations become untrue, or if I should ever believe that the Activity is not safe or is no longer safe for my child, that it will be my responsibility to immediately discontinue my child's participation in the Activity.

(2) I understand that the Activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my child's actions or inactions, those of others participating in the Activity, the conditions in which the Activity takes place, or the negligence of the "releasees" named below. I further understand that there may be other risks either not known to me or not readily foreseeable at this time, and I fully accept and assume all such risks and all responsibility for losses, cost, and damages that I may incur as a result of my child's participation in the Activity.

(3) I hereby give my approval of and consent to my child's participation in the Activity. I assume all risks and hazards incidental to the Activity and to transportation to and from the Activity. I hereby release, acquit, covenant not to sue, and forever discharge, and agree to indemnify and save harmless Universal Gymnasts, Inc., its owners, officers, administrators, employees, agents, volunteers, sponsors, advertisers, coaches and supervisors, and the owners or lessors of any facilities within which the Activity is conducted (including but not limited to Gienger, Inc.), their agents and employees, and all other persons providing facilities or assisting in the conduct of the Activity and in the transportation of participants to and from the Activity, of and from any and all actions, causes of action, claims, or demands, of whatever name or nature arising out of injuries to or death of the above named child as a result of the Activity and the transportation of the above named child thereto and therefrom.

(4) I have read this release and understand all of its terms. I understand that by signing this release, I am giving up substantial rights. I execute it voluntarily and with full knowledge of its significance.

Must click box to participate *

I've read the above release and agree.

Name of Parent/Guardian *

First Last

Please enter your full name. This will act as your signature.

Date Time *

MM / DD / YYYY