You must be over 18 to register for an account
Authorization, Release, and Legalities:
I authorize XCEL 360, LLC and its representatives to consent to medical treatment for me or my child when I cannot be reached to give consent. I also give XCEL 360, LLC and its representatives consent to administer the necessary emergency care to stabilize and/or improve the current injury or condition that I or my child may have sustained during activities related to XCEL 360, LLC instruction, practices, performances and any and all other activities. No prior determination of life-threatening emergency or danger of serious permanent injury resulting from treatment need be made under this authorization. Exceptions to this authorization are as follows:
I am fully aware that any activity involving motion, height, or athletic activities creates the possibility of serious injury, and I further agree to hold XCEL 360, LLC and its staff, officers, or representatives harmless for any injury or resulting expense(s) including but not limited to the risk of catastrophic injury, paralysis, and even death. I release and discharge all rights and claims against XCEL 360, LLC and its parties. Xcel 360, LLC, and all entities within the facility, strive to provide a maximum in safety procedures and guidelines and cannot assume responsibility for any accidents, injury, or illness that may occur. All athletes MUST have their own health insurance coverage in the event that any injury/illness may occur. I agree to assume all risk myself as the legal guardian and/or athlete of legal age.
I authorize XCEL 360, LLC to use photographs, video, and/or other likenesses of myself or my child for use in its promotional materials or sales and waive any rights of compensation or ownership thereto. I have read, understand, and agree to the XCEL 360, LLC financial policies. (Copies are generally available at the front desk or online.) I believe all of the information above to be complete and correct.
NOTICE TO THE MINOR CHILD’S
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF XCEL 360, LLC, OR ITS PARTIES USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM XCEL 360, LLC, OR ITS PARTIES IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND XCEL 360, LLC OR ITS PARTIES HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
(Florida Statute 744.301)
I understand that Every family is required to submit credit card information and to be on auto-pay. Accounts are due on the 1st of every month. If payment is not received by the 15th of the month (non-payment and/or declined credit card) a $10.00 late fee will be charged.
I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Xcel 360 in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For debit card charges to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of a credit/debit transaction being rejected for Non-Sufficient Funds (NSF) I understand that Xcel 360 may at its discretion attempt to process the charge again within 30 days, and agree to an additional $10.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of the transactions to my account must comply with the
provisions of U.S. law. I certify that I am an authorized user of the credit card/bank account in my Parent Portal and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated above.
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