2021 Fusion All Star Cheer Open Gym Waiver
Fusion All Star Trial Class and Open Gym Liability Waiver
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Email *
Child Name (Last, First) *
Child Birthdate *
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Parent(s)/Legal Guardian Name (Last, First) *
Parent/Legal Guardian Address (Number, Street, City, State, ZIP) *
Parent/ Legal Guardian Phone Number *
Parent/ Legal Guardian Email Address *
Emergency Contact (Name First, Last) *
Emergency Contact Phone Number *
How did you hear about Fusion All Stars?
Medical Authorization and Liability Release

EMERGENCY PROCEDURES: For minor injuries, Fusion All-Stars policy is to call the parent/guardian listed above, and follow their directions. In the rare case of a more serious injury, Fusion All-Stars policy is to first call 911, then call the parent/ guardian listed above.
EMERGENCY TREATMENT PRE-AUTHORIZATION: I authorize Fusion All-Stars and its representatives to consent to medical treatment for my child when I cannot be reached to so consent. I also give Fusion All-Stars 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 Fusion All-Stars participation, instruction, practices, or performances. No prior determination to life threatening emergency or danger of serious or permanent injury resulting from treatment need be made under this authorization.
MINOR INJURIES / MEDICATION: Fusion All-Stars will provide bandages for minor scraps & cuts. We do not provide medications.
SAFETY PROCEDURES / LIABILITY RELEASE: Fusion All-Stars strives to provide the maximum in safety procedures, guidelines, and enforcement, and therefore assumes no responsibility for any accidents or injuries that may occur. I am fully aware that any activity involving motion, height, athletic activity, and/or gymnastic equipment creates the possibility of serious injury, and I further agree to hold Fusion All-Stars and its staff and officers harmless for any injury or resulting expenses. I release and discharge all rights and claims against Fusion All-Stars and its parties.

Please list any physical/psychological limitation, injury, or weakness that may affect the athlete *
Please list any medications the athlete may be allergic to *
Insurance Carrier and Policy Number *
Consent
I understand that I am voluntarily giving up the right to bring a lawsuit or claim against the above mentioned Released Parties. I further understand and accept the above risks related to these activities. I have had sufficient opportunity to read this entire Agreement. I understand the Agreement, and I agree to be bound by its terms.

I HEREBY ACKNOWLEDGE (1) THAT THIS DOCUMENT IS ELECTRONICALLY SIGNED IN ACCORDANCE WITH UTAH CODE ANN. 46-4-201 AND (2) THAT THIS DOCUMENT IS VALID AND MAY BE ENFORCED IN THE SAME MANNER AS A HAND-SIGNED DOCUMENT THAT EXISTS IN PHYSICAL FORM. I ALSO EXPRESSLY ACKNOWLEDGE THE VALIDITY OF THE ELECTRONIC SIGNATURE APPENDED TO THIS DOCUMENT, WHICH WAS MADE BY ME ON THE DATE THIS FORM WAS ELECTRONICALLY SUBMITTED. I FURTHER AGREE THAT I HAVE KNOWINGLY AND EXPLICITLY WAIVED ANY RIGHT TO CLAIM THIS DOCUMENT IS INVALID OR IS UNENFORCEABLE BASED ON (1) THE FACT THAT THIS DOCUMENT EXISTS IN ELECTRONIC FORM OR (2) THE FACT THAT THIS DOCUMENT IS SIGNED ELECTRONICALLY.
I certify that I am the parent or legal guardian of the above minors and confirm that the information I entered is accurate and true. *
I am at least 18 years old and I have read and agree to the terms of the above agreement. *
By typing your name below, you are electronically certifying this waiver document just as if you would physically sign it if it was on paper. *
A copy of your responses will be emailed to the address you provided.
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