Champions Westlake - Participation Release Form You must be the parent of legal guardian of the participant(s) in order to submit this form. * Required Participant's Name * Participant's Date of Birth * Age * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 2nd Participant's Name 2nd Participant's Date of Birth 2nd Participant's Age 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Address * City/State/Zip * Home Phone * Allergies or Medical Conditions Parent's Name * E-mail Address Mom's Cell Phone * Mom's Work Phone Dad's Cell Phone Dad's Work Phone Liability Waiver As legal guardian, I hereby consent to the aforementioned person(s) participating in Champions Westlake activities and classes. I recognize that potentially severe injuries, including permanent paralysis or death, can occur in any activity involving height or motion including gymnastics and related activities such as tumbling and trampoline. I understand that it is the express intent of Champions Westlake to provide for the safety and protection of my child and, in consideration for allowing my child to use these facilities, I hereby release its officers, employees, teachers and coaches from all liability for any and all damages and injuries suffered by my child/ren while under the instruction, supervision or control of Champions Westlake. I give Champions Westlake permission to transport my child. As legal guardian of the aforementioned person(s), I hereby agree to individually provide for the possible future medical expenses which may be incurred by my child/ren as a result of any injury sustained while training at, or performing for, Champions Westlake. This acknowledgement of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent. Authorization * By clicking this checkbox, I agree to the above liability waiver Never submit passwords through Google Forms.
