R7, 2021-06-23

NOTE: Troy Gym Featuring IRC/MRC does not accept paper waivers, please submit electronically.

Troy Gym Liability Waiver

Any activity involving motion or height may cause serious accidental injury, paralysis or possible death. All gymnasts, parents, guests, relatives and guardians agree to abide by the rules and regulations set by Troy Gymnastics (posted on the walls and verbally communicated by staff) for the health, safety, and welfare of the participant. The Michigan Department of Community Health requires all athletes to be aware of the possibility of concussions while participating in sports.



Parents and guardians must review the following information with their child: A concussion is a type of brain injury caused by a bump, blow, or jolt to the head that changes the way the brain normally functions. Signs and symptoms of a concussion can include but are not limited to: headache, feeling pressure, nausea, vomiting, balance problems or dizziness, double or blurry vision, sensitivity to light or noise, feeling, hazy, foggy, groggy, problems concentrating, memory issues, confusion, or just not “feeling right”, appearing dazed, stunned, confused, clumsy, forgetful, having mood/behavior changes, one pupil larger than the other, being drowsy, feeling weak/numb, decreased coordination, vomiting, nausea, slurred speech, convulsion, seizures, or loss of consciousness. If a coach suspects a child/athlete has a concussion, he/she will be removed from play immediately. We recommend that parents/guardians follow up with their doctor if any concussion is suspected.

In addition, in case of medical emergency, I hereby give my permission via my signature below to hospitalize and secure proper treatment for the participant/s below. I hereby release Troy Gymnastics, its coaches, staff and ownership from all liability due to accidents occurring before, during or after the gymnastic instruction at the club. I further realize that Troy Gymnastics carries only liability and secondary insurance medical coverage, and that my participant/s is covered with the appropriate medical insurance needed. In signing this document, I irrevocably state that I

fully understand the terms and conditions set forth by Troy Gymnastics.



All information below must be completed and presented to the Troy Gymnastics staff to participate.



TROY GYMNASTICS INC* (TROY GYM) AND INDOOR ROPES COURSE, LLC(IRC) @ TG3* PARTICIPANT WAIVER & RELEASE OF LIABILITY


As legal guardian, parent or authorized representative, and/or one of the named persons and/or participant. I/We hereby give permission for named participants to have their temperature taken before participation in activities at Troy Gym*/IRC*; participate in activities at Troy Gym*/IRC*; and to work on all of the necessary equipment. I/We hereby give permission for any accompanying person to have their temperature taken before entry to any Troy Gym*/IRC* facility. We understand Troy Gym*/IRC* will keep confidential information regarding participants’ temperatures and reserves the right to exclude individuals from participation in activities based on this information in accordance with Troy Gym*/IRC*/State/Local/other policies. I/We understand that Troy Gym*/IRC* may inform other participants of any confirmed diagnosis of any transmittable virus/disease, to the extent they may have been exposed, but will maintain confidentiality to the extent possible; we waive all privacy-related claims based on such disclosure(s).

I recognize that participation in the high ropes course, inflatable, zip line activities, pool, and all Troy Gym*/IRC* events, activities and classes involve psychologically and physically challenging situations and that participation in these activities, or related activities including pre and post activities, could result in injuries including but not limited to sprains, cuts, rope burns and/or abrasions, or more serious injuries, including those that we may not be able to anticipate. I acknowledge that Troy Gym*/IRC* has/will informed me of all required safety regulations and that my failure to listen to and to follow the regulations and instructions may result in serious injury.

I understand that a physician should be consulted before participation in any physical activity and if I or any participant(s) on this form have one of the following conditions: are pregnant, have a musculoskeletal condition, high blood pressure, heart condition, diabetes or previous muscle or bone issues, including broken bones or surgeries related to that. I understand that an inhaler for exercise induced asthma, an Epi-pen for severe allergies or any other medication needed for a chronic medical condition should be brought with me or participant to any activity at Troy Gym*/IRC* and that we are not able to provide these for our participants. I acknowledge that my participation in said activities means I accept all the dangers that are open, obvious, and necessary to these activities.

I/We assume all risks and hazards incidental to the conduct of this activity and transportation to and from this activity. In case of emergency, the Troy Gym*/IRC* staff has my/our permission to use their judgment regarding treatment until I/we can be contacted. Moreover, I/we hereby authorize any qualified physician contacted to proceed with treatment. In case of emergency, I/we understand that participant(s) will be transported to the nearest hospital by the local emergency resource if the rescue squad deems necessary.

I/We understand that I/we will be responsible for all medical and emergency transportation expenses. It is understood that in some medical situations, the staff will need to contact the emergency resources before contacting the parent, emergency contact or other adult acting on the parents’ behalf.

Warning.... Catastrophic injury, paralysis, or death can result from improper conduct of this activity. I/We agree and consent that participation is voluntary and at everyone’s own risk. I/We acknowledge that participation entails known and unknown risks that may result in physical injury; the transmission of virus and/or disease; or other injury, loss, or death of any participant(s).

I/We understand that such risks simply cannot be eliminated. I/We knowingly, voluntarily, and expressly assume the risk of, and responsibility for, injury and damages. I/We specifically agree that the employees, owners, volunteers, and other agents of Troy Gym*/IRC* (“the Released Parties”) shall not be responsible for such injuries/damages, even if caused in whole or part by the negligence or fault of the Released Parties, whether such negligence is present at the signing of this Waiver or takes place in the future. This waiver and release do not apply to gross negligence or intentional torts by the Released Parties.

To the extent allowed by applicable law, I/we agree that we will waive, release, discharge, covenant not to sue, and indemnify and hold harmless (from all damages and expenses, including attorney fees) the Released Parties from any and all claims for injury and damage that the participant(s) listed on this form suffer, even if the risk(s) arise out of the negligence or fault of the Released Parties. By executing this Agreement, we agree that the Released Parties shall not be liable for any damages arising from personal injuries sustained by the participant(s) listed on this form as a result of any and all activities related to participation in activities at Troy Gym*/IRC* . To the extent allowed by applicable law, I/we agree that we will waive, release, discharge, covenant not to sue, and indemnify and hold harmless (from all damages and expenses, including attorney fees) the Released Parties from any and all claims for injury, illness and damage that any accompanying adult listed/unlisted on this form suffer, even if the risk(s) arise out of the negligence or fault of the Released Parties. By executing this Agreement, we agree that the Released Parties shall not be liable for any damages arising from personal injuries sustained by any accompanying adult listed/unlisted on this form as a result of accompanying a participating member at Troy Gym*/IRC*.

By signing, I/we expressly state that we have had sufficient opportunity to read and consider this entire Waiver and ask any questions associated with it; agree that we have read and understood it and voluntarily agree to be bound by its terms; and acknowledge that this Waiver contains a waiver and release of claims. We agree that if any portion of this Waiver is found to be void or unenforceable, the remaining portions shall remain in full force and effect.



CONCUSSION INFORMATION AND AGREEMENT


The Michigan Department of Community Health requires all athletes to be aware of the possibility of concussions while participating in sports. Parents and guardians must review the following information with their child: A concussion is a type of brain injury caused by a bump, blow, or jolt to the head that changes the way the brain normally functions. Symptoms of a concussion can include: headache, "pressure" in the head, nausea, vomiting, balance problems or dizziness, double or blurry vision, sensitivity to light or noise, feeling sluggish, hazy, foggy, groggy, problems concentrating, memory issues, confusion, or just not "feeling right". Signs of a concussion can include the individual appearing dazed, stunned, confused, clumsy, seeming forgetful, having mood or behavior changes, one pupil larger than the other, being drowsy, weakness, numbness, decreased coordination, repeat vomiting, nausea, slurred speech, convulsion, seizures, and loss of consciousness. If a coach suspects a child/athlete has a concussion, he/she will be removed from play immediately. We recommend that parents/guardians follow up with their doctor if any concussion is suspected and reserve the right to request a doctor's note before the athlete can return to play.


Click to Sign
Signature of Participant/Legal Guardian

If applicable

Wed Oct 27, 2021