DWIGGINS TUMBLING ACADEMY LLC (“COMPANYâ€)
WAIVER, RELEASE, INDEMNIFICATION, DEFENSE AND HOLD HARMLESS
AGREEMENT
BY CLICKING TO INDICATE YOUR ACCEPTANCE OF THESE TERMS OR OTHERWISE USING THE
SERVICES, YOU AGREE TO THESE TERMS AND ALL TERMS INCORPORATED BY REFERENCE. IF
YOU ARE ACCESSING OR USING OUR SERVICES ON BEHALF OF OTHER PERSON(S) (SUCH AS
YOUR CHILD(REN) OR MINOR(S) OF WHOM YOU HAVE LEGAL GUARDIANSHIP, YOU REPRESENT
THAT YOU ARE AUTHORIZED TO ACCEPT THESE TERMS ON THESE PERSONS BEHALF.
CERTIFICATION OF PHYSICAL FITNESS TO PARTICIPATE:
On behalf of myself and/or my child(ren) and/or other minor participant(s) under my legal guardianship
(collectively “PARTICIPANTâ€), I understand that one of the risks of participating in any sport, including
tumbling and gymnastics and related activities, is the risk of injury, including but not limited to serious
permanent injury, paralysis, and death. I also understand that one of the risks of participating in any activity at
a Company facility, including but not limited to Coach Trainings, Open Gym, Cheer, Ninja/Parkour/Tricking,
Acro/Dance jumps and leaps, Camps, Lessons, Training, Group Activities, and Parties, is the risk of injury,
including but not limited to serious permanent injury, paralysis, and death. To minimize the risk of injury to
Participant(s) and other persons and property, I agree myself and/or to instruct Participant(s) to obey all safety
rules and any other rules, regulations or restrictions set forth by any of the individuals associated with the
tumbling and gymnastics related activities. I further agree myself and/or to instruct Participants to fully report
and/or disclose any occurrences, issues, or problems related to my/his/her health or physical condition to
Company employees or coaches as soon as the problem arises or becomes noticeable.
I certify the following:
- I am authorized to execute this document and make decisions on behalf of myself and/or my Participant(s) as
his/her/their parent and/or legal guardian. I understand that this single waiver is valid for each and every
Participant or person under my care who is named on my account.
- That I and/or Participant(s) are not currently under the care of a physician for an injury or illness that would
prevent my and/or /his/her/their safe participation in tumbling and gymnastics related activities;
- That I and/or Participant(s) are not currently being treated for or recovering from an orthopedic or other injury
that would prevent my and/or his/her/their safe participation in tumbling and gymnastics related activities;
- That I and/or Participant(s) are not currently being treated for or recovering from a concussion or other
concussion-related injury that would prevent my and/or /his/her/their safe participation in tumbling and
gymnastics and related activities as described above;
- That I and/or Participant(s) have no history of fainting or any other problems whatsoever related to strenuous
exercise; and
- That I and/or Participant(s) are in good health and that, to the best of my knowledge, there is no reason I
and/or /he/she/they cannot or should not participate in the kind of physical activity involved with participation
in tumbling and gymnastics and related activities as described above.
ACKNOWLEDGMENT AND CONSENT
I acknowledge that Company IS NOT in any manner an insurer of my and/or Participant(s) safety. I hereby
affirm that I have the medical insurance, disability insurance, life insurance and/or resources that I deem
necessary and adequate to fully cover and insure my and/or my child’s and/or Participant(s) participation in
Company’s tumbling and gymnastics and related activities as set forth above, and the full costs of treatment in
case of any injury, death or illness.
2
In the event any accident, illness, injury or other medical condition arises in connection with my and/or
Participant(s) participation in Company’s tumbling and gymnastics and related activities as set forth above, I
hereby authorize Company, including any of its employees, staff or agents, to obtain medical treatment for me
and/or Participant(s), as the same may be deemed reasonably necessary by any such parties. I understand in the
event of a medical emergency, an EMS will be called to render assistance and that I will be financially
responsible for any expenses involved. I request that in my incapacity or in my absence I and/or Participant(s)
be admitted to any hospital or medical facility for diagnosis and treatment, and I request and authorize
physicians, dentists and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such
licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative
procedures and x-ray treatment to to myself and/or Participant(s).
PHOTO AND VIDEO RELEASE- In consideration for Participant(s) participation in Company’s tumbling
and gymnastics and related activities as described above, I hereby consent to having myself and/or
Participant(s) be photographed or video- or audio-taped during Company tumbling and gymnastics and related
activities as described above, and I agree that the images so obtained by the Company may be used for
educational, marketing and public relations purposes by Company without any further approval or
compensation for the same.
WAIVER, RELEASE, INDEMNIFICATION, DEFENSE AND HOLD HARMLESS
In consideration for PARTICIPANT(S) being allowed to participate in Company’s tumbling and
gymnastics related activities as set forth above, PARTICIPANT(S) and/or PARTICIPANT(S)
PARENT/GUARDIAN HEREBY AGREE TO WAIVE, RELEASE, INDEMNIFY, DEFEND and HOLD
HARMLESS the Company and its manager(s) and member(s), owner(s), employees, agents, and affiliates, for
myself, herself, himself, or themselves, and for my, her, his, or their descendants, heirs, issue, successors,
affiliates, and assigns, and any and all persons and entities claiming by, through, or under myself, her, him, or
them, from and against any damages, liability, claims, costs, fees, expenses, demands, charges, or grievances of
any kind or nature whatsoever (without limitation, known or unknown, liquidated or unliquidated, including,
but not limited to attorney fees and expenses which it may incur), whatsoever for and on account of any matter
growing out of or in any way connected with the Participant(s) participation in tumbling and gymnastics and
related activities as described above, under Company direction, on Company property, or using Company
property or facilities, and any activities incidental thereto, wherever, whenever or however the same may occur