WAIVER RELEASE FORM

 

MUST BE SIGNED AND RETURNED BEFORE ENTERING THE GYMNASIUM

 

PLEASE PRINT CLEARLY:

Child’s Name: _____________________________ Age : _______ DOB: ___________

Parent/Guardian Name: __________________________________________________

Address: ___________________________ City: _____________ State: ___ Zip: ____

Phone: _____________________________ Cell Phone: ________________________

Preferred Hospital: ________________________ Physician: ____________________

Are you a Flyaways Gold member?   Yes/No

 

RELEASE OF ALL CLAIMS FORM

 

In consideration of permission granted to my child(ren) by Flyaways Gold  Gymnastics Inc., and MD2B Inc. to participate in gymnastics & related activities under their supervision, I hereby release and discharge Flyaways Gold  Gymnastics, Inc., and MD2B Inc. of Forest Lake, MN,  it’s and their agents, employees, officers, shareholders, directors, successors and assigns from any and all claims, demands, judgments and executions which the undersigned and/or the undersigned’s child and/or the undersigned’s family had may have, or claim to have, against Flyaways Gold Gymnastics, Inc., and MD2B their agents, employees, officers, shareholders, directors, successors and assigns, for all personal injuries, property damage and other damages, known or unknown, real or personal, caused by or arising out of the above-described gymnastics  or related activities.  I further agree to indemnify and hold Flyaways Gold Gymnastic, Inc., and MD2B Inc., and their agents, employees, officers, shareholders, directors, successors and assigns, harmless from and against any and all such claims,  injuries or damages.

I give permission to Flyaways Gold Gymnastics Inc., and MD2B Inc.,  to take whatever emergency (e.g. first aid, disaster evacuation) measures that are judged necessary for the care and protection of my child(ren) while under the supervision of the center.

In case of medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency resource (police, rescue squad) deems it necessary.  The child will be transported at the expense of your primary medical coverage.

It is understood that in some medical situations, the staff will need to contact the local emergency resource before notifying the parent, child’s physician, and/or other adult acting on the parent’s behalf.

I, the undersigned, have read this release and understand its terms.  I execute it voluntarily and with full knowledge of its significance.

WARNING! CATASTROPHIC INJURY, PARALYSIS OR DEATH CAN RESULT FROM THE IMPROPER CONDUCT OF THIS ACTIVITY.

 

 

DATE:                                                                         SIGNED:

                        Month                Date              Year                                                              (Parent or Guardian)

 

DIRECTIONS TO Flyaways Gold Gymnastics: 

 

Coming from the South:

                                                                                                                                                                                                                Go north on interstate 35

                                                                Exit onto State Hwy 8

                                                                Exit off 8 at 2nd St NW

Take a right  at 2nd St.  NW – your entrance is on the right

 

Coming from the North

               

                                Go South on Interstate 35

Exit at Wyoming

Go left across the overpass to State Hwy 61

Turn right onto Hwy 61 approximately 3 miles

Turn right on to the entrance to State Hwy 8

Turn left on 2nd St NW and proceed under the overpass to the first parking lot. Entrance is on the right.