SVE Medical Authorization and Liability Release Forms

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This form is used to keep track of our members/guest and to help ensure a safe and fun environment for our athletes, employees, gym and anyone involved with Silicon Valley Elite.

Are you a Returning athlete member or new athlete member. (Click dropdown) *

I am interested in: (Check as many as you like) *

Recreational Classes/Workshops/Camps

Private Lessons

Mid-Season Prep/Novice Teams (All Levels of Experience) Ages 4 and up

Full Year Elite Teams (All Levels of Experience) Ages 4 and up

Other:

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Athlete(s) Full Name(s) *

Address *

Gender (Optional)

Male

Female

Prefer not to say

Other:

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Athlete(s) email. (Only used to create an account so they can sign in for classes. All athletes need a separate email from their parents/guardians email) *

Athlete(s) Phone number (optional)

Athletes Birthdate *

YYYY

Athletes age *

Parent/Guardian Names *

Parent/Guardian email *

Parent/Guardian mobile *

Emergency Contact Full Name and relationship. (Preferably someone that is not parent/guardian. This emergency contact is only called if parent/guardian do not answer and if we need to get ahold of someone) *

Emergency Contact Mobile *

Terms & Conditions (Check all the boxes) *

EMERGENCY PROCEDURES: For minor injuries, Silicon Valley Elite’s policy is to call the parent/guardian listed above, inform them, and follow their directions. In the rare case of a more serious injury, Silicon Valley Elite’s policy is to first call 911, then call the parent/guardian listed above. If, however, there is a question in the mind of any representative of Silicon Valley Elite as to whether an injury may not be minor and does not appear to be serious, said representative shall err on the side of caution and treat the injury as being serious thereby first calling 911 and then call the parent/guardian.

EMERGENCY TREATMENT PRE – AUTHORIZATION: I authorize Silicon Valley Elite and its representatives to consent to medical treatment for my child when I cannot be reached to consent. I also give Silicon Valley Elite permission to administer the necessary emergency care to my child to stabilize and/or improve the current injury or condition that my child may have sustained during activities related to Silicon Valley Elite’s instruction, practices, or performances. No prior determination of life-threatening or danger of serious permanent results from treatment need to be made under this authorization.

MINOR INJURIES/OTC MEDICATION: Silicon Valley Elite will provide bandages for minor scrapes and cuts. We will ONLY provide Tylenol/Advil with parent/guardian verbal consent (in person OR over the phone) each time a request is made. We do not provide any other medications.

LIABILITY RELEASE: I am fully aware that any activity involving motion, height, athletic activity and/or gymnastic equipment (i.e. Tumble-Trak, Trampoline, etc.) creates the possibility of serious injury, and I further agree to hold Silicon Valley Elite and its staff and officers harmless for any injury or resulting expenses. I am fully aware and understand that any virus including (COVID 19) is thought to spread mainly from person-to-person and direct contact. I release and discharge all rights and claims against Silicon Valley Elite and all its representatives including, serious injuries, minor injuries natural disasters and health conditions.

PUBLICITY RELEASE: The undersigned does hereby grant Silicon Valley Elite the unrestricted right to use the undersigned’s name, likeness, or appearance on any cheerleading/Tumbling advertising or marketing pieces such as but not limited to: Competition posters, calendars, film material, photographs, video material, computer software/hardware, electronic online services, or other similar promotional material in any form, content or medium in order to promote or market Silicon Valley Elite.

SPORTSMANSHIP: It is the goal of Silicon Valley Elite to provide a fun, competitive, innovative, and positive environment. We will not tolerate bad sportsmanship by participants, coaches, and fans/parents. We reserve the right to remove any person/persons who are unsportsmanlike or do not follow the directions of Silicon Valley Elite’s owners and staff.

SVE GYM PROGRAM: SVE charges an annual $99 registration fee for new class program athletes. In the event you join mid-month you will have the option of paying the $____ drop-in class rate for every class until the month is over, but you will have to pay the next month's tuition upfront the day of your first drop-in class.

RIGHT TO REFUSE SERVICE: SVE provides exclusive services for children, teens, and adults. We provide services that include mental and physical toughness through fitness and the sport of cheerleading. As a privately owned gym, SVE has the right to refuse service with no questions asked.

REFUNDS/GYM CREDIT: Refunds will NOT be given under any circumstances. Any services will be given as credit as soon as California permits us to provide services. Any tangible items will be available for pick up once we receive the item. Each family will be dealt with on a case by case basis. I understand that any credit or services used pre pandemic have expired January 2021.

Virtual/online and at-home Training: If SVE has to resort to virtual/online options due to COVID-19 or any natural disasters, I understand that any in-person service will be exchanged to a virtual situation to ensure athletes/parents still receive a modified service in return. Each athlete will also have access to communicate with coaches and receive virtual/online personal training. We will be having virtual options all throughout the season as long as it is sustainable. I understand that in-person training versus virtual/online training is different but due to COVID-19 I trust the gym's virtual/online program is the best modification. It is the athletes/parents responsibility to be accountable for attendance for virtual/online training.

COVID 19 RISKS: Protect yourself and others. The best way to prevent illness is to avoid being exposed to this virus. You can take steps to slow the spread by maintaining good social distance (about 6 feet). This is very important in preventing the spread of COVID-19. Wash your hands often with soap and water. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. Routinely clean and disinfect frequently touched surfaces. COVID-19 is thought to spread mainly through close contact from person-to-person. Some people without symptoms may be able to spread the virus. We are still learning about how the virus spreads and the severity of the illness it causes. I understand that if I have COVID 19 symptoms I must notify the gym immediately and must quarantine until tested negative for COVID 19 before returning to the gym. A written doctor's note must be presented to be able to return to training. Please refer to the following websites https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx https://www.cdc.gov/ https://www.smcgov.org/ for all COVID 19/diseases risks and info.

COVID 19 Person-to-person Spread The virus is thought to spread mainly from person-to-person, between people who are in close contact with one another (within about 6 feet) and respiratory droplets produced when an infected person coughs, sneezes, or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.COVID-19 may be spread by people who are not showing symptoms. The virus spreads easily between people. How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious, like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, which means it goes from person-to-person without stopping. The virus that causes COVID-19 is spreading very easily and sustainably between people. Information from the ongoing COVID-19 pandemic suggests that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious. The virus may be spread in other ways. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about how this virus spreads.

Required

Terms & Conditions (Check all the boxes) *

All Payments are non-refundable. Payments are never pro-rated...including cases of illness, injury, sitting-out for late payment, or quitting before your commitment contract ends

You must pay first and last month payment upon registering if you sign up for the monthly option

Registration fee is $99 and will expire at the end May (Included in special passes)

Late Payment: $35 fee (There is no payment “grace period”)

Returned Check: $30 fee no personal checks will be accepted for the remainder of the season

Athletes and families must follow all SVE rules and policies. Outside cheer gym attire is not allowed. We are allowed to dismiss athlete from program at anytime with no refund if there is negative or disrespectful behavior.

If athlete attends a class after membership expires it will cost our normal drop in rate of $30/class

Parents must notify us via email or come in person to cancel the membership.

A annual $99 registration fee will be charged June 1st every year.

Required

l adhere to all risks and policies set forth by Silicon Valley Elite. I agree to all the terms and conditions above and by typing my name below I will abide to all the terms and conditions, regardless if I checked the boxes or not. (Please type Full Legal Name as electronic signature below) *

I agree to all terms & conditions and I authorize Silicon Valley Elite to charge my card on file unless another form of payment is made. (If you are a SVE guest we most likely do not have your card on file but this is for future purposes) Please add full legal name below as an electronic signature. *

I hereby authorize Silicon Valley Elite All stars to charge my credit card for the following fees that are due. These fees will be charged on the specific dates that they are due. I understand that if I pay in full then my credit card will not be charged unless I give my verbal/written permission. Please type full name below as an electronic signature agreeing to the statement above. *

Credit/Debit Card Number

Credit/Debit Card Expiration date

Type of Card

Amex

Visa

Mastercard

Other:

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I understand the debit/credit card provided in person or via mindbody online account on file must remain valid while athlete(s) are attending classes/practices and/or enrolled in the program. I will notify Silicon Valley Elite All Stars of any changes to this account at least 15 days prior to the next billing date.I understand that this authorization will remain in effect until I cancel it in writing via email, I understand that the payments may be executed on the next business day. I certify that I am an authorized user of this credit card and will not dispute these scheduled transactions with my credit card company. *

YES

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