Please read the following carefully before signing

Download 13.71 Kb.
Date conversion01.02.2018
Size13.71 Kb.

In consideration for my participation in or with Atlantic Coast Kids, Inc. d/b/a Atlantic Coast Gymnastics, I agree to be legally bound by each of the following.
1) FINANCIAL POLICY: I realize I will not be permitted to take a class or attend a practice for which I have not paid. I realize I pay for my child’s spot in class and/or on team and am financially responsible for said spot whether or not my child attends class and/or team practice. I realize I am responsible for any and /or all expenses incurred by Atlantic Coast Kids Inc. in trying to collect payment for my unpaid bills. I hereby agree to personally guarantee payment for all tuition, assessments and fees owed and hereby waive any and all protection offered by bankruptcy in any form.



2) DISCLAIMER: Atlantic Coast Kids, Inc. d/b/a Atlantic Coast Gymnastics is not responsible for any injury or loss of property while practicing, training, taking class, competing, participating in open gym, special events, demonstrations or shows, or in any other way involved in gymnastics, cheerleading, preschool or teams at Atlantic Coast Kids, Inc. d/b/a Atlantic Coast Gymnastics for any reason whatsoever, including ordinary negligence on part of Atlantic Coast Kids, Inc. d/b/a Atlantic Coast Gymnastics, its owners, officers, agents, or employees.
3) WAIVER AND RELEASE: I am fully aware and appreciate the risks of physical injury and / or death associated with participation in gymnastics or cheerleading event, training, practice, class and/ or promotion. I further agree to assume responsibility of such for myself, my family and/or the gymnast(s) / cheerleader(s) listed below. In consideration of my participation, I hereby release and covenant not-to sue Atlantic Coast Kids, Inc. d/b/a Atlantic Coast Gymnastics, the Atlantic Coast Gymnastics Board of Directors and officers, and any of their employees, teachers, coaches or agents (Including Booster Clubs) from any and all present and future claims resulting from ordinary negligence on the part of Atlantic Coast Kids, Inc., or others listed for property damage, personally injury, or wrongful death, arising as a result of my engaging in or receiving instruction in gymnastics or any other activities incidental thereto, whenever, or however the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future, that may be made by me, my family, estate, heirs or assigns.
I understand that gymnastics and related activities always involve certain risks, including, but not limited to death, serious neck and spinal injuries resulting in complete or partial paralysis, brain damage, and serious injury to virtually all bones, joints, muscles and internal organs, and that the mats, pits and other safety equipment and apparatus provided for my child’s protection, including the active participation of a coach or teacher who will spot or assist in the performance of certain skills, may be inadequate to prevent serious injury. The risk of harm may be limited by all of the safety equipment and trained coaches, but never eliminated. I understand that participation in gymnastics and related activities involves activities incidental to active participation in gymnastics, including moving from event to event, conditioning, stretching and other activities which may leave me vulnerable to the actions of other participants who may not have complete control over the actions or who may not see other students in the gym. I am voluntarily participating in this activity with knowledge of the risks involved and hereby agree to accept any and all inherent risks of property damage, personal injury, or death.
I further agree to indemnify and hold harmless Atlantic Coast Kids, Inc. and all others listed for any and all claims arising as a result of my engaging in or receiving in instruction in Atlantic Coast Kids, Inc. activities or any activities incidental thereto, whenever, wherever, or however same may occur.
I understand that this waiver is intended to be as broad and is inclusive as permitted by the laws of the state of New Jersey and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be within the state of New Jersey.
4) TRANSPORTATION WAIVER AND RELEASE: In the event that transportation is provided to an activity by Atlantic Coast Kids, Inc. or a staff member, I hereby give permission for my child to travel to and from those activities in the vehicle provided and agree not to hold Atlantic Coast Kids, Inc., its directors, officers, agents or employees liable for any accident or injury suffered or contracted in connection with such travel.
5) MEDICAL ATTENTION: I hereby give my consent for USA Gymnastics, NJGA, Atlantic Coast Kids, Inc., or any Host organization to provide through Kennedy Memorial Hospital if possible or a medical staff of aforestated organization’s choice, customary medical athletic training attentions, transportation and emergency medical services as warranted in the course of my participation in gymnastics events, training, and / or practices.
6) INJURY REPORTING: I am fully aware of my responsibility to immediately report any and all injuries – no matter how insignificant- to my coach, instructor, and /or meet or event staff. I realize failure to do so will hinder proper medical treatment as well as insurance coverage. Furthermore, I realize it is my responsibility (with the Gyms help) to complete and process and insurance form within 90 days of the injury to help expedite insurance payment for treatment received.
7) MEDICAL HISTORY: I realize I am required to complete a medical and past injury history before taking a class and or participating in a USA Gymnastics, NJGA, and or Atlantic Coast Kids, Inc. event or class.
8) PHOTOGRAPHS: I hereby give my consent for USA gymnastics, NJGA, Atlantic Coast Kids, Inc., to publish any and all photographs and/or film taken of me while participating in or preparing for gymnastics. I will receive no financial payment for photographs / film.
9) SUPERVISION: I hereby place myself under the supervision of USA Gymnastics, NJGA, Atlantic Coast Kids, Inc. and as a result, can be removed from class, practice, and /or competition for unruly, uncooperative, disruptive and/or unsportsmanlike conduct. When removed for such behavior, I will forfeit the payment for that class, practice or event.
10) DISCOUNTS OR CREDIT: Discounts are only given due to illness and injuries over two weeks in duration. If the gymnast is placed on reduced schedule due to injury, tuition will be adjusted to the amount of hours attended.
11) INSURANCE DEDUCTIBLE: I realize that the insurance policy carried by Atlantic Coast Kids, Inc., will pay medical costs not paid for by my personal health insurance. Furthermore, I realize a $100.00 deductible is applied toward these medical expenses and I am responsible for this $100.00 deductible should I choose the lower registration fee as signified below.
I affirm that I am of legal age and am freely signing this agreement. Furthermore, I have read, understand and agree to the financial policy (Section 1) , Disclaimer (Section 2 ) and Waiver of release (Section 3) portions of this agreement. I have read this complete form and fully understand that by signing this form, I am giving up my legal rights and or remedies, which may be available to me for the ordinary negligence of Atlantic Coast Gymnastics, Inc or any person listed above. Intending to be legally bound, my/our signature is knowingly willfully offered hereto (All parents and legal Guardians must sign):
PRINTED NAME OF PARENT (S)_________________________________________Date__________
SIGNATURE OF PARENTS/GUARDIANS______________________________________________________________
GYMNASTS NAME____________________________________________________Date__________
SIGNATURE OF ATHLETE (Over 18 years)_________________________________ Date__________
*If a gymnast or cheerleader is under age 18, legal parent or guardian must read and sign this agreement.
INSURANCE DEDUCTIBLES: I have signified below with my initials, my choice of registration options.

________I choose the lower fee, which means I am responsible for any deductibles on medical bills.

________I choose the higher fee, which means I am NOT responsible for any deductibles on medical bills.
NOTE: Please give a complete medical and past injury history on a separate piece of paper.

The database is protected by copyright © 2016
send message

    Main page