Waiver Form | Scottsdale Gymnastics and Trampoline

For your convenience, our mandatory waiver form can be completed online using this form, up to four children. Please complete the following and submit to us, and please be sure to read our gym rules and policies.

Student Information

Student

First Name: *

Last Name: *

Birthdate: *

Sex: *

Medical Conditions:

Medications:

Allergies:

Add Student #2

First Name:

Last Name:

Birthdate:

Sex:

Medical Conditions:

Medications:

Allergies:

Add Student #3

First Name:

Last Name:

Birthdate:

Sex:

Medical Conditions:

Medications:

Allergies:

Add Student #4

First Name:

Last Name:

Birthdate:

Sex:

Medical Conditions:

Medications:

Allergies:

Contact Information

Address: *

City: *

State: *

Zip Code: *

Primary Parent/Guardian

Parent/Guardian First Name: *

Parent/Guardian Last Name: *

Parent/Guardian Mobile Phone: *

Add Additonal Parent/Guardian

Parent/Guardian First Name:

Parent/Guardian Last Name:

Parent/Guardian Mobile Phone:

Home Phone:

Work Phone:

Primary Email Address: *

Emergency Contact:

Emergency Phone:

What Event or Party Are You Attending: *

Terms and Conditions: *

Waiver and Release of Liability
As parent or legal guardian of the student named above, I understand and acknowledge the risks associated with the sport of gymnastics, cheerleading, and dance and other related activities, including paralysis and other catastrophic injury, as well as medical expenses and damages that may result or be associated with the sport of gymnastics and related activities as referenced above. This waiver and release of liability applies to and includes Kids Gone Wild LLC dba Scottsdale Gymnastics, its board of directors, officers, employees, instructors, agents, representatives, any independent contractors, including any and all instructors, landlords, and its successors as assigned. This waiver and release of liability shall not cover those situations where loss, injury or damage to the above participant is the result of the intentional and/or reckless conduct by any of the parties included in this waiver and release. The undersigned further agrees to indemnify and save and hold Scottsdale Gymnastics harmless, including all other parties identified above from any liability arising out of negligent or intentional conduct of students, parents, family members or parties invited upon the premises by the student or any family members which results in loss, injury or damage to any other party.

Minor’s Release Authorization
Without compensation to me or the student, I hereby grant to Kids Gone Wild LLC dba
Scottsdale Gymnastics the absolute right and permission to copyright, publish, and use photographic portraits, pictures, or videos of the minor for use through reasonable promotion of gymnastics and sports conducted by Scottsdale Gymnastics. I hereby waive any right that I or the minor may have to inspect or approve the finished media material as long as the matter is within reason and is not deemed to be socially inappropriate for use of the minor or student.

Medical Release
I Hereby authorize and give my consent to Kids Gone Wild LLC dba Scottsdale Gymnastics including any of its instructors or other authorized employees to provide emergency medical care and to give authority to any emergency unit, hospital or doctor to render immediate aid as might be required for the treatment of the above named student in the event of any emergency either on the premises of Scottsdale Gymnastics or during the course of any sports event involving the student as a Scottsdale Gymnastics participant.

Verification and Release
As legal parent, guardian or responsible party of this student, I hereby verify by my signature below that I accept the conditions of the waiver, release and indemnification; and furthermore I permit my child to participate in the events provided by Scottsdale Gymnastics.

By selecting this option and submitting this form, I acknowledge I have further read and fully understand the information above and accept this waiver and release of liability and I am fully informed of its content and meaning.

You must be over 18 years of age OR the parent/legal guardian of a minor under 18 years of age OR the legal guardian of an incapacitated and/or mentally challenged person in order to agree to the text above.

Please enter your date of birth: *

Please type your signature: *