2020 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

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 Country

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 Country

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? *

Programs Interested In

Preschool Age Classes Tumbling Performance Cheer All Star Prep Cheer All Star Cheer Special Events Parties

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.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 you or your child participating in any Virtual Class, Practice and/or Workout:1. You agree, represent, and warrant that:• You are in a safe space, free of obstructions• You are on a safe training surface• You are wearing the proper attire to do the workout• You are working out at your own risk, and if you feel uncomfortable doing any activity, you have the right to opt out2. You further agree that the Liability Release you executed prior to joining Total Inspiration Athletics shall extend and apply to this Virtual Practice, Class and/or Workout service, including but not limited to limitation of liability, indemnification, and assumption of risk.3. In the event the participant is a minor, you, as the parent or legal guardian, agree to the above on behalf of yourself and your minor child. You further agree that you will observe and monitor your minor child during the course of the activity.

I have read, understand, and agree to the virtual class liability statement above.

By signing this form you agree your are 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 photograph 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 l photo/video release statement above. *

I have read, understand, and agree with the photo/video release statement above.

Name *

First Name Last Name

Signature *

Clear