Dominique Dawes Gymnastics Academy Registration Waiver Release

DISCLAIMER: KQLD, LLC t/a Dominique Dawes Gymnastics Academy (“Dominique Dawes Gymnastics”) is not responsible for any injury (or loss of property) to any person while practicing, training, taking class, competing, participating in open gym, special events, demonstrations or shows, or in any other way involved in gymnastics, tumbling, trampoline, or ninja training (flips, rolls, jumps, kicks) and strength and agility training in general (collectively the “Activity”) at Dominique Dawes Gymnastics for any reason whatsoever, including ordinary negligence on the part of Dominique Dawes Gymnastics, its members, managers, agents, or employees, teachers, coaches, administrators, directors, agents, officers, volunteers, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place (hereinafter each a “Releasee” and collectively the “Releasees”). Additionally, the novel coronavirus, Coronavirus Disease 2019 (COVID-19), has been declared a worldwide pandemic by the World Health Organization and COVID-19 is highly contagious. As a result, federal, state, and local governments and federal and state health agencies have recommended social distancing and have, in many locations, prohibited the congregation of groups of people. Dominique Dawes Gymnastics, where possible, has and will continue to implement policies intended to reduce the potential for the spread of COVID-19, but cannot guarantee that any person will not become infected with COVID-19 as a result of attending or participating in any Activity at Dominique Dawes Gymnastics.

CONSENT: I consent to my/minor’s participation in the Activity and acknowledge that I fully understand my/minor’s participation may involve risk of serious bodily injury, permanent disability, paralysis, illness, or death, including losses which may result not only from my/minor’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the Activity is being conducted, and/or the rules of play of this type of Activity. I understand that if I have any risk concerns, I shall discuss them completely with the staff before I sign this agreement and before my/minor’s participation in the Activity begins. Further, by registering my/minor’s participation for the Activity, and utilizing the services, facilities or premises at Dominique Dawes Gymnastics, I affirm that I understand and voluntarily accept any increased risk to me, my family or members of my household of contracting COVID-19. I acknowledge and understand that the circumstances regarding COVID-19 are changing from day to day and that accordingly, U.S. Centers for Disease Control & Prevention guidance is regularly modified and updated, and I accept full responsibility for familiarizing myself with the most recent updates, as well as the changing conditions in our community, and all state and local orders.

ASSUMPTION OF RISK: Knowing and understanding the risks involved with participation in the Activity, including, but not limited to, those associated with the spread of COVID-19, I hereby voluntarily and willingly assume full and complete responsibility for all losses and damages, including injury, illness, and death, resulting from my/minor’s participation in the Activity, including transportation to and from the Activity. I agree I am financially responsible for any losses and damages resulting from my/minor’s participation in the Activity.

ATTESTATION: I affirmatively represent and attest that neither I, my minor, nor anyone in my household:

* is experiencing any symptom related to COVID-19 including, but are not limited to the following: cough, shortness of breath or difficulty breathing, chills, fever in excess of 100 degrees, muscle pain / body aches, sore throat, new loss of taste or smell, nausea, vomiting, and diarrhea. Symptoms may appear 2-14 days after exposure to the virus and range from mild symptoms to severe illness.
* has traveled internationally within the last 14 days.
* has traveled to a highly impacted area within the United States of America in the last 14 days.
* believe that they have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* has not been diagnosed with Coronavirus/Covid-19 and not yet cleared as not contagious by state or local public health authorities

I agree that should any of the above attestations change, so that there is an increased risk of infection of COVID-19 due to my/minor’s participation in the Activity, that I will immediately notify Dominique Dawes Gymnastics and agree to withhold my/minor’s participation in the Activity immediately until cleared for further participation by a medical professional licensed in the State of Maryland.

WAIVER: In consideration for my/minor’s participation in the Activity, I hereby waive all claims or causes of action, including ordinary negligence, against Dominique Dawes Gymnastics, and the Releasees, arising out of my/minor’s participation in the Activity wherever, whenever or however the same may occur, and further agree that if, despite this waiver and release of liability, and assumption of risk, I, or anyone on my/minor’s behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost (including attorneys’ fees and court costs), which any may incur as the result of such a claim.

I understand that this waiver is intended to be as broad and as inclusive as permitted by the laws of the State of Maryland and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be in the Circuit Court of Montgomery County, Maryland.

I have read this form and fully understand that by signing this form, I am giving up legal rights and or remedies which may be available to me/minor for the ordinary negligence of Dominique Dawes Gymnastics or any person listed above.

PHOTO & VIDEO RELEASE: I grant consent for my/minor’s picture to be taken or to be filmed while participating in activities at Dominique Dawes Gymnastics. I authorize Dominique Dawes Gymnastics to use and publish images, photographs, pictures, portraits, and audio, video and/or film footage of me/minor in all forms of media and in all manner for publication including, but not limited to, advertising and marketing campaigns, press releases, periodicals, and website use. I hereby waive any right I may have to review, inspect, edit or approve such publication and I release Dominique Dawes Gymnastics from any claims I may have against it for use of such images, photographs, pictures, portraits, and audio, video and/or film footage of me/minor.

Registration Waiver and Release Text
DISCLAIMER: KQLD, LLC t/a Dominique Dawes Gymnastics Academy (“Dominique Dawes Gymnastics”) is not responsible for any injury (or loss of property) to any person while practicing, training, taking class, competing, participating in open gym, special events, demonstrations or shows, or in any other way involved in gymnastics, tumbling, trampoline, or ninja training (flips, rolls, jumps, kicks) and strength and agility training in general (collectively the “Activity”) at Dominique Dawes Gymnastics for any reason whatsoever, including ordinary negligence on the part of Dominique Dawes Gymnastics, its members, managers, agents, or employees, teachers, coaches, administrators, directors, agents, officers, volunteers, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place (hereinafter each a “Releasee” and collectively the “Releasees”). Additionally, the novel coronavirus, Coronavirus Disease 2019 (COVID-19), has been declared a worldwide pandemic by the World Health Organization and COVID-19 is highly contagious. As a result, federal, state, and local governments and federal and state health agencies have recommended social distancing and have, in many locations, prohibited the congregation of groups of people. Dominique Dawes Gymnastics, where possible, has and will continue to implement policies intended to reduce the potential for the spread of COVID-19, but cannot guarantee that any person will not become infected with COVID-19 as a result of attending or participating in any Activity at Dominique Dawes Gymnastics. CONSENT: I consent to my/minor’s participation in the Activity and acknowledge that I fully understand my/minor’s participation may involve risk of serious bodily injury, permanent disability, paralysis, illness, or death, including losses which may result not only from my/minor’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the Activity is being conducted, and/or the rules of play of this type of Activity. I understand that if I have any risk concerns, I shall discuss them completely with the staff before I sign this agreement and before my/minor’s participation in the Activity begins. Further, by registering my/minor’s participation for the Activity, and utilizing the services, facilities or premises at Dominique Dawes Gymnastics, I affirm that I understand and voluntarily accept any increased risk to me, my family or members of my household of contracting COVID-19. I acknowledge and understand that the circumstances regarding COVID-19 are changing from day to day and that accordingly, U.S. Centers for Disease Control & Prevention guidance is regularly modified and updated, and I accept full responsibility for familiarizing myself with the most recent updates, as well as the changing conditions in our community, and all state and local orders. ASSUMPTION OF RISK: Knowing and understanding the risks involved with participation in the Activity, including, but not limited to, those associated with the spread of COVID-19, I hereby voluntarily and willingly assume full and complete responsibility for all losses and damages, including injury, illness, and death, resulting from my/minor’s participation in the Activity, including transportation to and from the Activity. I agree I am financially responsible for any losses and damages resulting from my/minor’s participation in the Activity. ATTESTATION: I affirmatively represent and attest that neither I, my minor, nor anyone in my household: * is experiencing any symptom related to COVID-19 including, but are not limited to the following: cough, shortness of breath or difficulty breathing, chills, fever in excess of 100 degrees, muscle pain / body aches, sore throat, new loss of taste or smell, nausea, vomiting, and diarrhea. Symptoms may appear 2-14 days after exposure to the virus and range from mild symptoms to severe illness. * has traveled internationally within the last 14 days.</li> * has traveled to a highly impacted area within the United States of America in the last 14 days. * believe that they have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. * has not been diagnosed with Coronavirus/Covid-19 and not yet cleared as not contagious by state or local public health authorities I agree that should any of the above attestations change, so that there is an increased risk of infection of COVID-19 due to my/minor’s participation in the Activity, that I will immediately notify Dominique Dawes Gymnastics and agree to withhold my/minor’s participation in the Activity immediately until cleared for further participation by a medical professional licensed in the State of Maryland. WAIVER: In consideration for my/minor’s participation in the Activity, I hereby waive all claims or causes of action, including ordinary negligence, against Dominique Dawes Gymnastics, and the Releasees, arising out of my/minor’s participation in the Activity wherever, whenever or however the same may occur, and further agree that if, despite this waiver and release of liability, and assumption of risk, I, or anyone on my/minor’s behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost (including attorneys’ fees and court costs), which any may incur as the result of such a claim. I understand that this waiver is intended to be as broad and as inclusive as permitted by the laws of the State of Maryland and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be in the Circuit Court of Montgomery County, Maryland. I have read this form and fully understand that by signing this form, I am giving up legal rights and or remedies which may be available to me/minor for the ordinary negligence of Dominique Dawes Gymnastics or any person listed above. PHOTO & VIDEO RELEASE: I grant consent for my/minor’s picture to be taken or to be filmed while participating in activities at Dominique Dawes Gymnastics. I authorize Dominique Dawes Gymnastics to use and publish images, photographs, pictures, portraits, and audio, video and/or film footage of me/minor in all forms of media and in all manner for publication including, but not limited to, advertising and marketing campaigns, press releases, periodicals, and website use. I hereby waive any right I may have to review, inspect, edit or approve such publication and I release Dominique Dawes Gymnastics from any claims I may have against it for use of such images, photographs, pictures, portraits, and audio, video and/or film footage of me/minor.
Type of Event*
Party Child Name/Open Gym Session/Other*
Consent*
I affirm that I am of legal age and am freely signing this agreement.
Signature Agreement*
By typing your name you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
Signature*
Date
Date Format: MM slash DD slash YYYY
Print Full Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Participant Name (One Child Per Form)*
Participant Name (One Child Per Form)- old
First Last
Participant DOB*
Date Format: MM slash DD slash YYYY
Gender*
- Female
- Male
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