Waiver Form

ASSUMPTION OF RISK, MEDICAL AUTHORIZATION, &WAIVER OF LIABILITY

Waiver Form: I, _____________________ the undersigned, am either the parent or legal guardian of the minor/minors below. __________________, __________________, ________________, _________________(Participant’s full name). I am fully aware that participating in gymnastics, tumbling, trampoline, dance, cheerleading, birthday parties, special events, activities, and sports involving height and/or motion may result in illness, injury, permanent paralysis or death to the participant. These activities can include unforeseeable risks including, but not limited to, equipment failure, spotting failure, employee negligence, participant negligence, and acts of natural forces. Being fully knowledgeable of these dangers and risks I ASSUME AND ACCEPT ANY AND ALL RISKS of injury or death associated with our participation.

Allowing my child(ren) to use these facilities, I, on my behalf of my child(ren) and our respective heirs, administrators, executors and successors, COVENANT NOT TO SUE AND FOREVER RELEASE, WAIVE INDEMNIFY AND HOLD HARMLESS Millcreek Gymnastics and Cheer Inc., Janet Cecil and any owner or employee or adult supervisor without limitation damages, injuries or death resulting from participation in Millcreek Gymnastics and Cheer Inc. activities and/or unforeseeable risks including acts of negligence.

Participant does not have any medical conditions that would prevent or hinder safe participation in the program. If your child requires an inhaler, or has other medical conditions, I understand I am required to stay with him/her or get a doctor’s release.

If an emergency does arrive I would like my child(ren) to be taken to a hospital for medical treatment and I hold Millcreek Gymnastics and Cheer Inc., its owners and its employees harmless in their retrieving medical care. I hereby agree to individually provide for all possible future medical expenses that may incur as a result of my child’s participation in the Millcreek Gymnastics and Cheer Inc. program and/or any injury that occurs during such participation.

Participant shall pay any attorney fees or costs incurred by Millcreek Gymnastics and Cheer Inc. in enforcing this agreement.

GUARDIAN OF PARTICIPANT HAS READ CAREFULLY AND FULLY UNDERSTANDS THE CONTRACT AND THE ASSUMPTION OF RISK, MEDICAL AUTHORIZATION AND WAIVER OF LIABILITY. I SIGN THIS OF MY OWN FREE WILL. I acknowledge that I am the guardian and understand the terms of the agreement.

________________________________            __________________________          ____________
Signature                                                                                   Print Name                                                       Date

__________________________________              __________        ________________________
Child’s Name (if more than one, list on back)                       Date of Birth            Emergency Contact (Incl. ph.#)

________________________________             __________________________________
Insurance Carrier and ID #                                                  Medical Conditions

___________________________________          _____________     _______________
Mailing Address                                                                              Phone #                         Cell #

Email Address: ___________________________________________________________

Print this waiver

 

ASSUMPTION OF RISK, MEDICAL AUTHORIZATION, & WAIVER Form OF LIABILITY

I, _____________________ the undersigned, am either the parent or legal guardian of the minor/minors below. __________________, __________________, ________________, _________________(Participant’s full name/s). I am fully aware that participating in gymnastics, tumbling, trampoline, dance, cheerleading, birthday parties, special events, activities, and sports involving height and/or motion may result in illness, injury, permanent paralysis or death to the participant. These activities can include unforeseeable risks including, but not limited to, equipment failure, spotting failure, employee negligence, participant negligence, and acts of natural forces. Being fully knowledgeable of these dangers and risks I ASSUME AND ACCEPT ANY AND ALL RISKS of injury or death associated with our participation.

Allowing my child(ren) to use these facilities, I, on my behalf of my child(ren) and our respective heirs, administrators, executors and successors, COVENANT NOT TO SUE AND FOREVER RELEASE, WAIVE INDEMNIFY AND HOLD HARMLESS Millcreek Gymnastics and Cheer Inc., Janet Cecil and any owner or employee or adult supervisor without limitation damages, injuries or death resulting from participation in Millcreek Gymnastics and Cheer Inc. activities and/or unforeseeable risks including acts of negligence.

Participant does not have any medical conditions that would prevent or hinder safe participation in the program. If your child requires an inhaler, or has other medical conditions, I understand I am required to stay with him/her or get a doctor’s release.

If an emergency does arrive I would like my child(ren) to be taken to a hospital for medical treatment and I hold Millcreek Gymnastics and Cheer Inc., its owners and its employees harmless in their retrieving medical care. I hereby agree to individually provide for all possible future medical expenses that may incur as a result of my child’s participation in the Millcreek Gymnastics and Cheer Inc. program and/or any injury that occurs during such participation.

Participant shall pay any attorney fees or costs incurred by Millcreek Gymnastics and Cheer Inc. in enforcing this agreement.

GUARDIAN OF PARTICIPANT HAS READ CAREFULLY AND FULLY UNDERSTANDS THE CONTRACT AND THE ASSUMPTION OF RISK, MEDICAL AUTHORIZATION AND WAIVER OF LIABILITY. I SIGN THIS OF MY OWN FREE WILL. I acknowledge that I am the guardian and understand the terms of the agreement.

________________________________            __________________________          ____________
Signature                                                                                       Print Name                              Date

__________________________________                                   __________        ________________________
Child’s Name (if more than one, list on back)                      Date of Birth            Emergency Contact (Incl. ph.#)

________________________________             __________________________________
Insurance Carrier and ID #                                          Medical Conditions

___________________________________                       _____________                _______________
Mailing Address                                                                              Phone #                         Cell #

Email Address: ___________________________________________________________

Millcreek G&C Policies and Procedures Form

  • Payment Information

**Each family is required to have credit card information on file or payment of last month’s tuition as a deposit.

You have the option to make payments as follows:

  1. Automatic payment from checking account: Automatic Withdrawal
  2. Credit Card

Please make check pay able to: Millcreek Gymnastics and Cheer

Please note the student’s name, class day and time on the memo portion of the check.

A $25.00 NSF fee will be charged for all Insufficient Funds (check or credit card)

You may mail payments to Millcreek Gymnastics & Cheer 3955-A Wasatch Blvd. SLC, UT 84124

­­­­­­­­­__________ I’ve read the above and agree

  •  Registration Fee

The yearly registration fee is $35.00 which is non-refundable and not prorated. Registration fees are paid at the time of initial month of registration and every March there-after. Wrist Gaurds are mandatory to purchase. $65.00 New or $50.00 Used.

______________ I’ve read the above and agree.

  •  Tuition

Tuition is due on the 15th of the month prior to the lesson month (example: February’s tuition is due by January 15th) and late on or after the 16th. A $20.00 late fee is applied if payment is received on or after the 16th of the month. If you are unsure of the amount you owe you should write a check for an estimated amount and we will settle the difference in a timely manner. Tuition is non-transferable and non-refundable. Tuition-payments can be by the month or up to three months in advance. If tuition is not paid by the end of the month your credit card or Autopay will be charged by Millcreek G&C for any unpaid balances.

_____________ I’ve read the above and agree.

You authorize Millcreek Gymnastics and Cheer to automatically charge your credit card or Autopay for any balance due at the end of each month. You agree to contact Millcreek Gymnastics and Cheer with any concerns and any credit card expirations at least 30 days prior to the start of the new tuition cycle to allow for corrections. A separate form is required for automatic credit card withdrawal, charges will continue until a 30 day written notice is provided.

______________ I’ve read the above and agree.

  •  Withdrawal Policy

You understand that you must fill out a completed Millcreek G&C withdrawal form provided by the office one month to six weeks prior to withdrawing your child from the program. Notice must be given before the 15th or you will need to finish out the month that was paid for. Until this notice is on file, you are responsible for payment in full. You realize this space could have been made available to another child. The Fall Schedule runs for the entire school year (Summer Schedule is for June, July and part of August).

______________ I’ve read the above and agree.

  •  Make up & Cancellation Policy

Make up classes are offered as a courtesy. Cancellations that are requested at least 24hrs in advance may qualify for a make-up session that will be held once per month. Make-up sessions are only held once per month, which means that you can only make-up one cancellation per month. Refunds are never given for cancellations. Students should minimize cancellations for the benefit of their training. Students have partners in class and it is difficult for your child’s partner if your student is excessively absent. Please take your scheduling serious as Millcreek G&C does. Our policy is strict because we require a commitment to the program and your child’s partners. Excessive cancellations are hard on everyone involved and will not be tolerated.
______________ I’ve read the above and agree.

Please do not bring in crying babies or children that will disrupt class in the viewing area. Running, jumping, yelling, climbing and all other horseplay is strictly forbidden. All children must be accompanied by an adult while in the viewing area. Parents are responsible for their children while in the viewing area, parking lot and common grounds. Management does not take responsibility and is not liable for any injuries and/or lost and damaged personal property occurring in the viewing area, parking lot or other common grounds of Millcreek G&C. Please be considerate of others while at Millcreek G&C. Management reserves the right to ask those not respecting these guidelines to leave.

______________ I’ve read the above and agree.

  • Days we are Closed

 

  • Punctuality

Please be on time to both the start and end of your child’s lesson. Students may not be dropped off more than 5 minutes before the start of their lesson. While we understand that occasionally you may be a few minutes late, excessive tardiness will not be tolerated. There is a fee of $10 if you are 15 minutes late and an additional $5 every 5 minutes after the first 15. It is neither courteous nor fair to the other children, their parents and the coach if you are late in dropping off or picking up your child.

______________ I’ve read the above and agree.

Shoes Not Allowed on Gym Mats or Floor

Shoes are never allowed on the gym mats or flooring. Everyone must remove their shoes before stepping onto the floor. Please do not come out onto the gymnastics floor without being invited to do so.

No Interacting with Students during the Lesson

This includes no coaching from the sidelines and no talking with your child during the lesson.

Because this is distracting to both the students and the coaches we only allow parents to stay for the entire lesson for one class during the first week of the month. For the rest of the month parents are still welcome to come in 5 minutes early to pick your child up and watch them show off their skills.

______________ I’ve read the above and agree.

All Students must be in a sturdy gymnastics leotard with their hair pulled back.

I have read, understand and agree to comply with Millcreek Gymnastics & Cheer’s policies regarding Tuition & Payments, Withdrawal, Make up & Cancellations, Viewing, Closing, Punctuality, Shoes Not Allowed on Gym Mats or Floor and No Interacting with Students during the Lesson. I also agree to read and abide by Millcreek Gymnastics & Cheer’s complete policies and procedures document on Millcreek Gymnastics & Cheer’s website www.millcreekgym.com.

__________________________________

Print Name

­­­­­­­­­­­­­­__________________________________                 _________________

Signature                                                                                            Date

  •  Release of Liability

You understand that it is the express intent of the Millcreek Gymnastics & Cheer to provide for the safety and protection of your child and, in consideration for allowing your child to use these facilities, you hereby release Millcreek Gymnastics & Cheer it’s officers, employees, teachers and coaches, from all liability for any and all damages and injuries suffered by your child while under the instruction, supervision, or control of the Millcreek Gymnastics & Cheer

______________ I’ve read the above and agree.

  • Acknowledgement of Risk

As parent/legal guardian, you hereby consent to the person participating in the Millcreek Gymnastics and Cheer programs. You recognize that potentially severe injuries, including permanent paralysis or death can occur in any activity involving height or motion, including gymnastics. You also realize that your child will be performing and training on all gymnastics events plus various other training devices including trampoline.

______________ I’ve read the above and agree.

  • Medical Release

You specifically appoint Millcreek Gymnastics & Cheer to authorize emergency medical treatment for your child, to execute consent, orders or other documents for any medical procedure which is required to save the life of your child, or to prevent a deterioration of any existing or new medical condition, or to stabilize any medical condition, which may or may not deteriorate, as fully as you could if you were present. This acknowledgement of risk, waiver of liability and medical release having been read thoroughly and understood completely, is signed voluntarily as to its content and intent.

______________ I’ve read the above and agree.

Print Name___________________________________________________

Signature_____________________________________________________Date___________________

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