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Child’s Name
Child’s Age
School
Grade/Teacher
Parent/Guardian Name
Email
Phone Number
Emergency Contact/Relationship to Child
Emergency Contact Number
Does your child attend ELP?
Yes
No
During Conduct School
Authorized Pick Up #1
*
Authorized Pick Up #2
“Does your child have any allergies, medical conditions, or limitations?”
1. Acknowledgment of Risk
I understand that participation in gymnastics and physical activity carries inherent risks, including, but not limited to, minor injuries (such as sprains or bruises) and serious injuries (such as fractures, head injuries, or paralysis). I understand that Energee In Motion is a mobile program that may operate in various locations including schools, parks, churches, or private homes, and that each location presents its own unique environment and conditions.
2. Voluntary Participation
I voluntarily enroll my child in Energee In Motion’s mobile gymnastics program and understand that participation is entirely voluntary. I acknowledge that my child is in good physical health and has no known condition that would restrict safe participation in physical activity.
3. Release of Liability
In consideration for my child’s participation, I hereby release and hold harmless Energee In Motion, its owners, employees, agents, contractors, facility partners, and volunteers from any and all claims, liabilities, demands, or causes of action related to injury, illness, or property loss arising out of or in connection with my child’s participation in any program activity, whether on-site or during transport of equipment.
4. Medical Authorization
I authorize Energee In Motion staff to administer basic first aid to my child in the event of injury and, if necessary, to contact emergency medical personnel. I accept full responsibility for any medical expenses incurred as a result of injury or illness sustained during participation.
5. Behavior & Conduct
I understand that Energee In Motion reserves the right to remove any participant from the program due to behavioral issues, safety concerns, or repeated failure to follow instructions. No refunds will be given under such circumstances.
6. Facility Use & Equipment
I understand that all equipment provided is inspected regularly and used appropriately by trained staff. However, due to the mobile nature of the business, equipment will be set up on varied surfaces (grass, floors, carpet, concrete, etc.), and precautions will be taken to ensure safety. I acknowledge these variable conditions and accept the associated risks.
7. Photo/Video Release
I grant permission to Energee In Motion to use photographs or video footage of my child for marketing, social media, and educational purposes. No names or identifying information will be shared without additional permission.
I do NOT grant permission
8. Assumption of Risk During Outdoor or Off-Site Programs
I understand that when the program is held in public or outdoor locations, external factors such as weather, surface conditions, or public interference may affect safety. I trust that all reasonable precautions will be taken by the staff to ensure a secure environment.
9. Cancellation & Refund Policy
I acknowledge that classes missed due to personal reasons (sickness, absence, etc.) may not be refunded unless otherwise stated. Cancellations due to weather or school closures may be rescheduled when possible.
10. Acknowledgment of Understanding
I have read this waiver fully and understand its contents. I voluntarily agree to all terms, and I understand that this release applies to each class/event my child participates in with Energee In Motion.
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