Waiver - Midstate Strong

Parent Name

Child's Name

Emergency Phone Number

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Date

Release Agreement & Waiver

I, the undersigned parent and/or guardian of the registering student, certify that by registering my child with Midstate Cheer and Tumbling Gym, that I am aware of the inherit risks associated with participation in and participating for gymnastics, sports, tumbling, and other exercises engaged in by participants in the Gym. I, and my child, understand that participation in gymnastic practice is entirely our choice and it is with understanding if risks of accidental injury involved in any activity involving unusual motion or height, that I have given my full consent for my child to take part in these activities with Midstate Cheer and Tumbling Gym. I certify that I have contacted my child’s Physician about his/her participation in the program. With this release form, I also certify that any medical expenses, should an injury occur, are covered by my insurance policy, or will otherwise be borne, by me personally. I also authorize any authorized hospital, or licensed health care practitioner to perform an examination or render emergency treatment, which may be necessary in the event my child is injured during his/her participation in Midstate Cheer and Tumbling Gym activities if I am not present to direct the course of my child’s treatment. In consideration of my child being allowed to participate in Midstate Cheer and Tumbling program, I hereby, for my child, personally, assume all risks in connection with Midstate gymnastics program, and I further release Christopher and Savannah Lovecchio, Midstate Cheer and Tumbling, and its employees and agents, from any and all liability for any injury or damage which may occur as a result of my child’s participation in the Gym’s program, including all risks connected therewith, whether foreseen or unforeseen, and further, to save and hold harmless Midstate Cheer and Tumbling, and it’s employees, from any claim by me individually or on behalf of any child, his/her family, estate, heirs, or assigns, arising out of his/her enrollment and participation in Midstate Cheer and Tumbling. I have fully informed myself of the contents of this release agreement by reading it before accepting the terms. I agree that no oral representations, statements, or inducements apart from the foregoing written release agreement, have been made. I agree that the foregoing release agreement and waiver are intended to be as broad and inclusive as permitted by the law of the State of Louisiana, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect

MIDSTATE sTRONG