Small Wonders Gymnastics

At Small Wonders Gymnastics, we are dedicated to providing your child with a fun, safe, and memorable experience.  However, on occasion, accidents may happen, therefore we require your prior consent for your child’s participation in activities at Small Wonders Facility. 

PLEASE READ CAREFULLY THIS ASSUMPTION OF RISK, WAIVER OF LIABILITY AND MEDICAL AUTHORIZATION.  COMPLETE AND SIGN THIS FORM. YOU MUST HAVE THIS FORM SIGNED TO PARTICIPATE.

Parent or Legal Guardian: _____________________ Relationship: _________________

 

Child’s Name: _____________________Age_________   Home Phone: _____________

 

Home Address: ___________________________________ Cell Phone______________

 

Emergency Contact: __________________________ Relationship: _________________

 

Phone Number: ___________________ Alternate Number: _____________________

ASSUMPTION OF RISK, WAIVER OF LIABILITY, MEDICAL AUTHORIZATION

As Legal Guardian of ________________________________, I recognize potentially severe injuries, including but not limited to permanent paralysis or death can occur in sports or activities involving height or motion, including but not limited to gymnastics, tumbling, trampoline, and dance and cheerleading.  Being fully aware of these dangers, I voluntarily consent to the aforementioned person participation in any and all Small Wonders programs and activities and I ACCEPT ALL RISKS associated with that participation. 

In consideration for allowing my child to use these facilities, I, on own behalf and the behalf of my child and our respective heirs, administrators, executors and successors, hereby covenant NOT TO SUE and FOREVER RELEASE SMALL WONDERS, ITS OFFICERS, DIRECTORS, SHAREHOLDERS, EMPLOYEES OR AGENTS. 

IN THE EVENT OF AN EMERGENCY, I would like my above mentioned child to be taken to the hospital for medical treatment and I HOLD SMALL WONDERS, AND IT’S REPRESENTATIVES HARMLESS IN THEIR EXECUTION OF THIS ACTION.  Additionally, I hereby agree to individually provide for all possible future medical expenses which may be incurred by my child as a result of any injury sustained while participation at or for SMALL WONDERS. 

I HAVE READ AND UNDERSTAND THIS ASSUMTION OF RISK AND WAIVER OF LIABILITY AND MEDICAL AUTORIZATION AND I VOLUNTARILY SIGN MY NAME IN AGREEMENT.

  

LEGAL GUARDIAN SIGNATURE  ___________________________________                                              DATE