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Assumption of Risk, Release of Liability for Personal Injury, Medical Authorization

 

I, _________________________________, for myself and as the parent and/or legal guardian of  _____________________________________, understand the nature of gymnastics activities and the inherent dangers involved in such activity. I hereby release, discharge, covenant not to sue, and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the OLD TOWN/ORONO YMCA gymnastics department, its instructors, and employees, from any and all liability, claims, demands, losses or damages in any way related to my or my child’s use of the facilities, equipment, or apparatus of OLD TOWN/ORONO YMCA.  I further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releasee, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim, to the fullest extent permitted by law.

 

By signing this release, I acknowledge my understanding and acceptance of the following:

  1. That gymnastics is an active sport, which requires strength, agility and concentration and that it is solely my responsibility to determine that my child is in good health and good physical and mental condition before permitting my child to exercise, work out, receive instruction or perform.
  2. That gymnastics requires twisting, turning, tumbling, jumping, extension and rotation, which movements are often performed with considerable force and/or at considerable height and which can result in severe, permanent personal injuries, including, but not limited to, bruised, strained, sprained or torn muscles, tendons and ligaments, broken bones, derangements or dislocations of joints, concussion, brain damage, nerve and spinal cord injury, paralysis and death.
  3. That gymnastics requires the use of apparatus and equipment, which may cause or contribute to severe, permanent personal injuries, such as those described above.

 

I give permission for Old Town/Orono YMCA gymnastics coaches to administer first aid in cases of minor injuries, and in cases of sever injury until trained medical personnel can be reached.  I authorize Old Town/Orono YMCA coaches to give permission for emergency medical treatment if reasonable effort to contact parent/guardian has failed, and qualified medical personnel consider treatment necessary.  Additionally, I hereby agree to individually provide for all possible future medical expenses, which may be incurred by my child as a result of any injury, sustained while participating at or for OLD TOWN/ORONO YMCA.

 

I have read the Release of Liability for Personal Injury and have been given the opportunity to speak with a representative of OLD TOWN/ORONO YMCA before signing this release.

 

Signature of Parent or Guardian: _____________________________________________

 

Print Full name: _____________________________________________ Phone: ____________________

 

Emergency Contact: ________________________________________________________ Phone: ____________________

 

Date: ___________/__________/___________

 

Refund and Cancellation Policy

Refund requests must be received at least three days prior to the start of a session in order to receive a full refund.  After this time, any refund requests received within the three days prior to the start of a session will be refunded 80% of the total fee.  There will be no refunds or a credit granted once a session has begun.

A minimum number of participants are required to hold classes. When registration is below the minimum, the Old Town/Orono YMCA reserves the right to cancel the program with participants receiving full refund. It is highly recommended that you register as early as possible to avoid programs being cancelled due to lack of enrollment.


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