Wavier

Waiver for all summer camp sessions

This waiver is valid for all Open Gyms, Classes, and Parties that your child is attends at Encore Elite Wildcatz, LLC in 2016

SUMMER CAMPS WAIVER OF LIABILITY / MEDICAL / PUBLICITY RELEASE FORM FOR ENCORE ELITE WILDCATZ, LLC

* Indicates required field

My child voluntarily and with my permission participates in Open Gym/ Classes/ Parties at Encore Elite Wildcatz, LLC All Star Cheerleading, and all use of equipment and flooring. *

Yes No

Insert Child's Name *

Child(s) Allergies / Medication *

Please read and sign below:

As parent or guardians understand that by the very nature of the activity cheerleading and gymnastics carry a risk of physical injury. No matter how careful the participants or what landing surface is available, the risk cannot be eliminated completely. The risk of injury includes minor injuries such as muscle pulls, dislocation and broken bones. The risk also includes catastrophic injuries such as permanent paralysis or even death from landings or falls on the back, neck, or head. In consideration of your allowing ”child” to participate in Open Gym/ Classes/ Parties at Encore Elite Wildcatz, LLC All Star Cheerleading program, and intending to be legally bound, I do hereby for myself and my heirs, executors and administrators, forever release, absolve and discharge Elite Wildcatz, LLC All Stars, which includes but is not limited to all the owners, coaches, instructors, staff, employees, parents, cheerleaders, sponsors, and participants, from all liabilities and waive any and all rights and claims for damage which I may have or may hereafter accrue as a result of injury, disability or death sustained or suffered by “child” in connection with his/her association with or participation in the Encore Elite Wildcatz, LLC All Stars Cheerleading program/ Open Gym/ Classes/ or Parties.

It is important that “child” is in good health and has no previous illness or injury that could be complicated by physical activity. Since “child” is participating in Open Gym/ Classes/ Parties at their own risk Encore Elite Wildcatz, LLC assumes no responsibility. “Child” should always consult a physician before doing any physical activity.

I do hereby acknowledge that “child” has insurance coverage and that I accept the financial responsibility for care and/ or treatment “child” should need in the case of an emergency during or as a result of any and all participation with the Encore Elite Wildcatz, LLC All Star Cheerleading program/ Open Gym/ Classes or Parties. I agree not to hold Encore Elite Wildcatz, LLC, which includes all aforementioned persons, financially responsible for care and/or treatment needed in case of an injury, sickness, accident, and/or death to ”child.” In the event of an emergency resulting in injury, accident, sickness, and/or death the designated emergency adult listed in the box below will be contacted.

I hereby give my permission for “child” to be photographed, videotaped, and / or audio taped during any participation with the Encore Elite Wildcatz, LLC All Stars Cheerleading program. I further give permission for such photographs, videotapes, and audiotapes to be used in print or broadcast media as deemed appropriate for promotion of the Encore Elite Wildcatz, LLC All Stars Cheerleading program.

I have read and agree to the above waiver and liability *

Yes No

Insert Parent(s) or Guardian(s) Name *

Email *

Phone Number *

Emergency Contact:

Insurance Info:

Emergency Contact Name *

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Last

Child Name *

First

Last

Relationship *

Emergency Contact Address *

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Line 2

City

State

Zip Code

Country

Date of Birth (01/01/2016 format) *

Home Address *

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Line 2

City

State

Zip Code

Country

Phone Number *

Responsible Insurance Party Name *

First

Last

Mobile Phone Number *

Insurance Company *

Physician Name *

First

Last

Policy Number *

Physician Phone Number *

Submit

Waiver for all summer camp sessions

​SUMMER CAMPS WAIVER OF LIABILITY / MEDICAL / PUBLICITY RELEASE FORM FOR ENCORE ELITE WILDCATZ, LLC

Please read and sign below:

Emergency Contact:

Insurance Info:

SUMMER CAMPS WAIVER OF LIABILITY / MEDICAL / PUBLICITY RELEASE FORM FOR ENCORE ELITE WILDCATZ, LLC