461 West Street, Amherst, MA 01002 (413)256-6990
Hampshire Gymnastics School
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  • Waiver and Release Form

    ​REGISTRATION FORM

    See class schedule for day and times.

    WAIVER AND RELEASE FORM

    Prior to participation, this form must be signed (by checking the 'I agree' box) by at least one of the participants parents or legal guardians if the participant is not yet 18 years old. Participants signatures are required if 18 years of age or older.

    In consideration of Hampshire Gymnastics School, Inc. allowing the student to participate in sports activity, class, competition, team, including non-gymnastics activities such as birthday parties and playground activities (hereinafter referred to as the "Activity"), I, and if I am not 18 years old, my parents or legal guardians, agree to be bound as follows (the term "I" in this release refers to both the student and his or her parents or legal guardians):

    (1) Acknowledgment and Assumption of Risks. I understand that the Activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by the students actions or inactions, those of others participating in the Activity, the conditions in which the Activity takes place, the negligence of the "Released Parties" named below, or other causes. I further understand that there may be other risks either not known to me or not readily foreseeable at this time. I fully accept and assume all such risks and all responsibility for losses, costs and damages that may result from the Activity. I hereby give my approval of and consent to the student's participation in the Activity. I assume all risks and hazards incidental to the activity and to transportation to and from the Activity.   

    (2) Representation of Ability to Participate. I understand the nature of the Activity, and I represent that the student is qualified, in good health, and in proper physical condition to participate in the Activity. Should I ever believe that any of the above representations have become untrue, or if I should ever believe that the Activity is not safe or is no longer safe for the student, then it will be my responsibility immediately to discontinue the student's participation in the Activity.

    (3) Release. I hereby release, acquit, covenant not to sue, and forever discharge Hampshire Gymnastics School, Inc., it's owners, officers, administrators, employees, agents, volunteers, sponsors, advertisers, coaches and supervisors, and the owners or lessors of any facilities within which the Activity is conducted, their respective agents and employees and all other persons providing facilities or assisting in the conduct of the Activity and in the transportation of participants to and from the Activity (collectively the "Released Parties") of and from any and all actions, causes of action, claims, demands, liability, losses or damages of whatever name or nature, including but not limited to those arising from or in any way related to the negligence of any of the Released Parties, that arise out of or are connected in any way to the student's participation in the Activity and the transportation of the above named student to and from the Activity (collectively the "Released Claims").

    (4) Indemnification. I will defend, indemnify and hold harmless the Released Parties from (that is, to reimburse and be responsible for) any loss or damage, including but not limited to costs and reasonable attorney's fees (including the cost of any claim I might make or that might be made on my behalf or the student's behalf that is released in this document), arising out of or connected in any way with any of the Released Claims.

    I have read the Student Information Sheet, Safety Form and/or Team Handbook and agree to abide by all rules and conditions set forth therein and to accept the judgement of the program officials in this regard. 

    (5) Use of photographs and videos. I further agree that Participants involved in Hampshire Gymnastics School, Inc. programs/activities may be filmed and/or photographed and such videos/photographs may be used to publicize/advertise Hampshire Gymnastics School, Inc. programs or activities.

    My typed name and choice of 'I agree' indicates that I have read and understood this acknowledgement and assumption of risks, representation of ability to participate, release and indemnification. I understand that by electronically signing (clicking 'I agree') this document, I am giving up substantial rights. I am executing this document voluntarily and with full knowledge of its significance.

    CONSENT TO TREAT FORM

    In consideration of Hampshire Gymnastics School, Inc. allowing the student to participate in sports activity, class, competition, team, including non-gymnastics activities such as birthday parties and playground activities (hereinafter referred to as the "Activity"), I, and if I am not 18 years old, my parents or legal guardians, agree to be bound as follows (the term "I" in this release refers to both the student and his or her parents or legal guardians):

    I authorize Hampshire Gymnastics School, Inc. to provide to the participant, through medical personnel of its choice, customary medical assistance, transportation, and emergency medical services should the student require, such assistance, transportation or services as a result of injury or damages related to participation in the Activity. If the student is a minor and parent or guardian is not present, efforts will be made to contact a parent or guardian that are reasonable under the circumstances, but treatment will not be withheld if a parent or guardian cannot be reached. 

    I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage, which I consider adequate for the participant's protection. This consent shall remain effective until one year from the date below unless sooner revoked in writing and delivered to Hampshire Gymnastics School, Inc., 461 West St., Amherst, MA 01002.

    I have read and understood this consent to treatment and am executing this document voluntarily and with full knowledge of its significance.

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Hampshire Gymnastics School     461 West Street, Amherst, MA 01002     (413)256-6990