2026 Total Inspiration Athletics Liability Release
Child 1 Name
*
First Name
Last Name
Child Date of Birth
*
Child 2 Name
First Name
Last Name
Child 2 Date of Birth
If registering for After School Cheer Club, enter your school name
Parent 1 Name
*
First Name
Last Name
Parent 2 Name
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Person Responsible for Billing
*
First Name
Last Name
Person Responsible for Billing Phone (If different from above)
-
Area Code
Phone Number
Person Responsible for Billing Email (if different from above)
example@example.com
Person Responsible for Bill Address (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any injuries, illnesses, or accidents that may limit participation? Please be sure to note Child 1 and Child 2.
*
Any allergies or medications? Please be sure to note Child 1 and Child 2.
*
Insurance Provider
*
Insurance Policy Number
*
How did you hear about us?
*
Friend Referral
FaceBook
Google
Other
Programs Interested In
*
Tumbling Classes
All Star Cheerleading Teams
One on One Lessons
School Vacation Camps
Birthday Parties
Kids Night Out
I give permission for the above named child(ren) to participate in the programs of Total Inspiration Athletics. I understand that cheerleading, tumbling, stunting, and jumping are skills learned under the direction of certified and trained professionals and therefore, should only be practiced in an appropriate setting with the proper supervision. I realize that any activity involving height or motion can create the possibility of injury. I also understand that cheerleading, tumbling, stunting, and jumping are inherently dangerous activities where injury or even death may occur. I waive and release any liability, claims, suits, damages, losses, and expenses from injuries and damages suffered by the above name child/children in connection with any programs associated with Total Inspiration Athletics or Tia Forlizzi. In the event of an emergency, I give permission to Total Inspiration Athletics to give above named First Aid/CPR and/or arrange transportation to a hospital for emergency medical treatment. I will assume all costs and expenses for medical care.The above named child/children are physically able to participate in activities without limitations unless otherwise stated above. If for any reason, I myself, or any additional guest in relation to the above named child enters the facility, gym, lobby of Total Inspiration Athletics, and/or a mobile program facility for any reason I waive and release any and all injuries and damages suffered as a result. My signature below is my indication that I have read, understand, and agree with the liability release statement above.
*
I have read, understand, and agree with the liability release statement above.
By signing this form I agree that my minor child is voluntarily participating in the activities outlined above and assume risk of any illness, injury, damage, or loss whether arising out of negligence or otherwise.
*
I have read, understand, and agree to the statement of assumed risk above.
I grant Total Inspiration Athletics, its employees and representatives permission to take photographs and/or videos of the above named and it's property. I agree that Total Inspiration Athletics may use such photographs/videos for any lawful purpose including, but not limited to advertisement, publicity, and web content. My signature below is my indication that I have read, understand, and agree with the photo/video release statement above.
I have read, understand, and agree with the photo/video release statement above.
Name
*
First Name
Last Name
Signature
*
Date
*
-
Month
-
Day
Year
Date
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