Participant's Name *

First Name

Last Name

Date of Birth *

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Participant's Name #2

First Name

Last Name

Date of Birth

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Parents/Guardian Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PLEASE READ THE FOLLOWING CAREFULLY AND CHECK 'I AGREE' WHEN YOU ARE READY TO PROCEED I recognize that severe injuries, including virus, broken bones, sprains, permanent paralysis or death, can occur in sports or activities involving height or motion, those activities include but are not limited to gymnastics, tumbling, trampoline, aerials, dance, cheerleading and fitness classes. Being fully aware of these dangers, I hereby give consent for my child and myself to participate in any and all Gym Skills Panama City, LLC (“Company”) programs and activities (the “Activities”) and I ACCEPT ALL RISKS associated with this participation. I am fully aware of the risks and potential hazards connected with participating in the Activities, including but not limited to, risk of injury. I voluntarily allow my child to engage in the Activities, knowing that the Activities may be hazardous to my child. I acknowledge that my child is in good physical condition and I do not know of any medical or physical condition or other reason that my child should not participate in the Activities or which could interfere with my child’s safety in the Activities, or else I am willing to assume, and bear the cost of, all risks that may be created, directly or indirectly, by any such condition. In consideration for my own or my child's participation I hereby, for myself and my child and our respective heirs and successors RELEASE, WAIVE, DISCHARGED, AND COVENANT NOT TO SUE Company, its officers, directors, shareholders, employees, contractors, and volunteers (collectively, the “Releasees”) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child, myself, or any relative, or to any property belonging to me, whether caused by the negligence of the Releasees or otherwise, while participating in the Activities, or while in, on, or upon the premises where the Activities are being conducted. I HEREBY EXPRESSLY RECOGNIZE AND ASSUME ALL RISKS ASSOCIATED WITH PARTICIPATION IN THE ACTIVITIES AND VOLUNTARILY RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE, AND HOLD HARMLESS THE RELEASEES. I AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM ANY LOSS, LIABILITY, DAMAGE, OR COSTS, INCLUDING COURT COSTS AND ATTORNEY FEES, THAT MAY BE INCURRED AS A RESULT OF PARTICIPATION IN THE ACTIVITIES WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. It is my express intent that this Participation Release, Consent, and Waiver of Liability shall bind all of the members of my family and spouse, if I am alive, and my heirs, assigns, and personal representatives. Consent to Photography and Publicity I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for me or my child’s participation, I hereby grant my permission for my child's likeness to be used in Company’s publicity and advertising. Consent to Medical Treatment In the event of an accident or emergency, I hereby authorize my child to be transported to a hospital for medical treatment and I hold Releasees harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by myself or my child as a result of any loss, damage, or injury, including death, sustained during or arising out of the Activities. I acknowledge and represent that I have read the foregoing, understand each and every provision, and sign it voluntarily. No oral representations, statements, or inducements, apart from the foregoing written agreement, have been made. I represent that I am at least eighteen (18) years of age and am fully competent and that I am the parent or guardian of the athlete named above. I further represent that I execute this Participation Release, Consent, and Waiver of Liability for full, adequate, and complete consideration, fully intending to be bound by the same. *

I agree with the above terms