REVOLUTION GYMNASTICS, LLC 494 Service Center Road Brookville, PA 15825 814/849-2160 Email:
WAIVER and RELEASE OF LIABILITY, ASSUMPTION OF RISK, and INDEMNITY AGREEMENT I understand the nature of the activity in which I am participating in at REVOLUTION GYMNASTICS, LLC and I represent that I am in good health, qualified, and in proper physical and mental condition to participate in such activity. I further acknowledge that if I believe event conditions are unsafe, at any time, I will immediately discontinue my participation in the event. I also fully assume and accept all risks and responsibility for losses, costs, and damages I incur as a result of my participation in any activity. I hereby release, discharge, and covenant not to sue above said REVOLUTION GYMNASTICS, LLC, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, sponsors, advertisers, and if applicable, owners and lessors of premises on which the activity takes place from all liability, claims, demands, losses or damages on my account. I have read the RELEASE OF LIABILITY and WAIVER, ASSUMPTION OF RISK, and INDEMNITY AGREEMENT, and I understand that I have given up substantial rights by signing it. I have signed it freely and without any inducement or assurance of any nature. I intend this to be a complete and unconditional release of ALL liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall be in full force and effect. To Be Filled Out By Parent of Minor Print name of Athlete __________________________________________ Date __________________ Signature of Athlete ___________________________________________________________________ **if athlete is a minor-parent is to sign athlete’s name** PARENTAL CONSENT I, the minor’s parent and/or legal guardian, understand the nature of the activities my child is enrolled waive and release any and all rights against REVOLUTION GYMNASTICS, LLC, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, sponsors, advertisers, and if applicable, owners and lessors of premises on which the activity takes place from all liability, claims, demands, losses, damages or injury that may be suffered by me or my child in connection with our affiliation or enrollment in gymnastics, or any other activity sponsored by REVOLUTION GYMNASTICS, LLC. Printed name of Parent __________________________________ Date _______________ Signature _____________________________________________________________________________ Address ______________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________