DWIGGINS TUMBLING ACADEMY LLC (“COMPANY”)

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 ANOTHER PERSON (SUCH AS
YOUR CHILD OR A MINOR OF WHOM YOU HAVE LEGAL GUARDIANSHIP, YOU REPRESENT THAT
YOU ARE AUTHORIZED TO ACCEPT THESE TERMS ON THAT PERSON'S BEHALF. 
CERTIFICATION OF PHYSICAL FITNESS TO PARTICIPATE:
On behalf of myself and/or my child and/or other minor participants under my legal guardianship (collectively
“PARTICIPANT”), I understand that one of the risks of participating in any sport, including tumbling and
gymnastics related activities, is the risk of injury, including but not limited to serious permanent injury,
paralysis, and death. To minimize the risk of injury to my child and other participants, I agree myself and/or to
instruct any minor under my legal guardianship 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 my any minor under my legal guardianship 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 child and/or any
minor under my legal guardianship as his/her parent or legal guardian.
- That I and/or my child and/or any minor under my legal guardianship are not currently under the care of a
physician for an injury or illness that would prevent my/his/her safe participation in tumbling and gymnastics
related activities;
- That I and/or my child and/or any minor under my legal guardianship are not currently being treated for or
recovering from an orthopedic or other injury that would prevent myhis/her safe participation in tumbling and
gymnastics related activities;
- That I and/or my child and/or any minor under my legal guardianship are not currently being treated for or
recovering from a concussion or other concussion-related injury that would prevent my/his/her safe
participation in tumbling and gymnastics related activities;
- That I and/or my child and/or any minor under my legal guardianship have no history of fainting or any other
problems whatsoever related to strenuous exercise; and
- That I and/or my child and/or any minor under my legal guardianship are in good health and that, to the best of
my knowledge, there is no reason I/he/she cannot or should not participate in the kind of physical activity
involved with camp participation.
ACKNOWLEDGMENT AND CONSENT
I acknowledge that Company IS NOT in any manner an insurer of my and/or my child’s and/or any minor under
my legal guardianship’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 any minor under my legal guardianship’s participation in Company’s tumbling and gymnastics related
activities and the full costs of treatment in case of any injury, death or illness.
In the event any accident, illness, injury or other medical condition arises in connection with my and/or my
child's and/or any minor under my legal guardianship participation in Company’s tumbling and gymnastics-

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related activities, I hereby authorize Company, including any of its employees, staff or agents, to obtain medical
treatment for me and/or my child and/or any minor under my legal guardianship, 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 absence my child and/or any minor under my legal guardianship 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 the above minor.
I hereby consent to having myself and/or my child and/or any minor under my legal guardianship be
photographed or video- or audio-taped during Company activities, and I agree that the images so obtained may
be used for educational, marketing and public relations purposes by Company.
In consideration for PARTICIPANT being allowed to participate in Company’s tumbling and
gymnastics related activities, PARTICIPANT 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 or himself
and for my, her or his descendants, heirs, issue, successors, affiliates, and assigns, and any and all persons and
entities claiming by, through, or under myself, her or him, 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 activities under Company direction, on Company property, or using Company
property or facilities, or any activities incidental thereto, wherever, whenever or however the same may occur.