Must be signed by parent or guardian before child can participate.

In consideration of the permission granted my child to participate in any Empire Gymnastics sports activity, class, after school activity, competition, team, including non-gymnastics activities such as swimming and playground activities (hereinafter referred to as the "Activity"), I, the parent or legal guardian of the above-named child, make the following representations: 

(1) I understand the nature of the Activity that my child will participate in, and I represent that, to the best of my knowledge, my child is qualified, in good health, and in proper physical condition to participate in the Activity. I further represent and acknowledge that, should I ever believe that any of the above representations become untrue, or if I should ever believe that the Activity is not safe or is no longer safe for my child, that it will be my responsibility to immediately discontinue my child's participation in the Activity. 

(2) I understand that the Activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my child's actions or inactions, those of others participating in the Activity, the conditions in which the Activity takes place, or the negligence of the "releases" named below. I further understand that there may be other risks either not known to me or not readily foreseeable at this time, and I fully accept and assume all such risks and all responsibility for losses, cost, and damages that I may incur as a result of my child's participation in the Activity. 

(3) I further acknowledge, understand, appreciate and agree that my participation may result in possible exposure to and illness from infectious diseases, including, but not limited to, MRSA, Influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation and exposure. 

(4) I hereby give my approval of and consent to my child's participation in the Activity. I assume all risks and hazards incidental to the Activity and to transportation to and from the Activity. I hereby release, acquit, covenant not to sue, and forever discharge, and agree to indemnify and save harmless Empire Gymnastics its owners, officers, administrators, employees, agents, volunteers, sponsors, advertisers, coaches and supervisors, and the owners or lessors of any facilities within which the Activity is conducted, their agents and employees, and all other persons providing facilities or assisting in the conduct of the Activity and in the transportation of participants to and from the Activity, of and from any and all actions, causes of action, claims, or demands, of whatever name or nature arising out of injuries to or death of the above named child as a result of the Activity and the transportation of the above named child thereto and there from. 

(5)I hereby give my consent for:

(1) the administration to my child of any treatment deemed necessary by any licensed physician or dentist; and 

(2) the transfer of my child to any hospital that is reasonably accessible. This authorization does not cover major surgery unless the opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery. Facts concerning my child’s medical history (allergies, medications being taken, physical impairments, etc.) are as follows: 

(6) I have read the Policies and Procedures for parents, spectators, and participants in the Activity and/or the Team Handbook and agree to abide by all rules and conditions set forth therein and to accept the judgment of the program officials in this regard. I agree to the use of my child’s image on our website or in advertisements. I have read this release and understand all its terms. I understand that by signing this release, I am giving up substantial rights. I execute it voluntarily and with full knowledge of its significance.

Sign and Date below