Athletes Plus Commerical

Posted by Athletes Plus on Thursday, January 10, 2013

WAIVER FORM

Please complete the electronic waiver form. The information will be sent to us via email. If you wish to complete the waiver form on paper, please download the waiver form, fill it out completely, and return the completed form to us.

Form Title
  • Name*full name
    0
  • Address*address, city, state, zip
    1
  • DOB*date of birth
    2
  • Age*age
    3
  • How did you hear about us?*
    4
  • Parent Name*parent name
    5
  • Phone Number*phone number
    6
  • Phone Number*optional
    7
  • Phone Number*optional
    8
  • Alt. Contact*name & number
    9
  • Email*a valid email address
    10
  • Email*optional
    11
  • Please Choose One*
    Parent/Child Tumbling Class
    Preschool Tumbling Class
    Beginner Tumbling Class
    Intermediate Tumbling Class
    Advanced Tumbling Class
    Cheernastics Tumbling Class
    Back Handspring Tumbling Class
    All-Stars Competitive Cheer Team
    Prep Team
    Special Needs Cheer Team
    School Camp or Private Lessons
    12
  • All-Stars Competitive Team*if known, if applicable
    13
  • Medication*medication
    14
  • Allergies*allergies
    15
  • Doctor's Name*doctor's name
    16
  • Doctor's Phone*doctor's phone
    17
  • Insurance Carrier*insurance carrier
    18
  • Policy Number*policy number
    19
  • Emergency Contact*if not listed above
    20
  • Emergency Number*if not listed above
    21
  • Please list*any additional physical/psychological limitation, injuries, or weakness that may affect the athlete's participation.
    22
  • ATHLETES PLUS RELEASE WAIVER I am the parent or legal guardian of the athlete named above. My child has my full consent to participate in any Athletes Plus program. I am aware that in cheerleading, dance, and tumbling, as in any sport involving height and motion, the possibility of serious and catastrophic injury is present. On behalf of my child, I voluntarily assume all risks of loss or injury that my child may sustain from participation in the Athletes Plus programs. In consideration of my child being permitted to participate in the Athletes Plus programs, I release and discharge Athletes Plus and/or its owners, officer, directors, employees, agents, and personnel from any and all liability for any damage or injury which results from or arises out of my child’s participation in the Athletes Plus programs, I also agree to waive all claims that I or my child may have against Athletes Plus and/or its owners, officer, directors, employees, agents, and personnel which results from or arises out of my; child’s participation in the Athletes Plus programs. I further agree to indemnify and hold harmless Athletes Plus, and/or its owners, officers, directors, employees, agents, and personnel from and against any and all demands, claims, costs (including attorney’s fees), and causes of action arising, directly or indirectly, from my child’s participation in the Athletes Plus programs, including those liabilities which arise from the negligent acts and/or omission of Athletes Plus, it’s owners, officers, directors, employees and personnel to treat all injuries occurring on the premises. I give my permission for my child’s picture to be used on our website or brochures. I have carefully read this release and authorization, I fully understand its contents, and I am signing this on my own free will.
    23
  • Parent/Legal Guardian*full name
    24
  • Date*today's date
    25
  • 26