PERMISSION TO PARTICIPATE, WAIVER OF RESPONSIBILITY, AND MEDICAL RELEASE

We, the staff of New Heights Gym, L.L.C. recognize our obligation to make students and their parents aware of the risks and hazards associated with the sport of gymnastics, tumbling, and cheerleading.   Students may suffer injuries, possibly minor, serious, or catastrophic in nature during the course of gymnastics, tumbling, or cheerleading activities.   Parents should make their children aware of the possibility of danger and encourage their children to follow all the safety rules and coaches’ instructions.   Children should be dressed in either a leotard or elastic waist shorts and a t-shirt.   Children will be limited to skills that they can safely perform, based on physical conditions and previous experience.  

With the above in mind, and being fully aware of the risks and potential for injuries which can occur in gymnastics, tumbling, cheerleading, and activities involving movement, trampoline, and exercise, I consent to have my child, _______________________, participate in activities on equipment owned and/or used by New Heights Gym, L.L.C.  

I hereby agree that I for myself, my child(ren) adopted or otherwise, my heirs and executors waive and release any and all rights and claims for damages occurred at any time against New Heights Gym or its agents and representatives for any injury or damages in connection with my association with gymnastics or other activities sponsored by New Heights Gym, L.L.C.

I understand that New Heights Gym, LLC staff members are USAG safety-certified and are professional members of USA Gymnastics, but are not physicians or medical practitioners of any kind.   I, the undersigned, give the instructors, staff and responsible adults the power to authorize medical or other treatment of the student named below.   I understand that the instructors, advisors, or others may have some skills in first aid, CPR, and, at their discretion, I authorize them to use those skills and techniques to assist in any circumstances in which they judge their skills would be necessary or helpful.   I hereby release New Heights Gym, LLC staff to render first aid to my child in the event of injury or illness, and if deemed necessary by New Heights Gym, LLC staff, the calling of an ambulance for the said child.

  Date of Event:   __________   Child’s Name:   _______________________    Child’s Age: ____