ASSUMPTION OF RISK RELEASE, WAIVER OF LIABILITY, AND MEDICAL RELEASE FORM
In consideration of UpScale Athletics, LLC, allowing this individual(s) to participate in any sports activity,
class, competition, team, including non- gymnastics activities agree to be as follows (the term "I" in this
release refers to both the athlete(s) and his or her parents or legal guardians):
I will discuss with my participant all rules and policies of the gym. It is important that all participants follow
coach’s instructions, techniques, and training to decrease or eliminate any injury. I will agree and obey to all
coaching instructions.
INITIAL_____________
I understand and recognize the severe dangerous risk of activity of my athlete’s participation. I understand
the risk of a serious brain, neck, or spinal injury, which could result in paralysis, serious injury to all internal
organs, to bones, ligaments, tendons, muscles, other bodily organs, and even death. I hereby, assume all
risks including serious impairment with all physical activities with participation in program. I fully accept and
assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation
in any sport or non-sport activity at UpScale Athletics, LLC.
INITIAL______________
I authorize UpScale Athletics, LLC to provide to the participant(s), through medical personnel of its choice,
customary medical assistance, transportation, and emergency medical services should the participant(s)
require such assistance, transportation, or services as a result of injury or damage related to participation in
any activity. If the participant(s) and/or parent or guardian is not present, efforts will be made to contact a
parent or guardian that are reasonable under the circumstances, but treatment will not be withheld if a
parent or guardian cannot be reached.
INITIAL______________
The parent or guardian's name and phone number is as follows: _______________________________.
I also affirm that I now have and will continue to provide proper health and accident insurance coverage
which I consider adequate for the participant(s) protection. This consent shall remain effective for the
duration of this athlete being a participant. I approve minor first aid by UpScale Athletics, LLC and staff. The
above parental/guardian contacts will be contacted in case of an emergency of injury or illness. I understand
and will pay all debts associated with treatment if my participant needs hospital care. INITIAL_____________
I certify that my participant(s) is in good health and physical condition and is fully able to participate in the
programs of Upscale Athletics, LLC. If my participant at any time is not of good health, I will communicate in
writing by physician’s note of instruction for participant to UpScale Athletics, LLC. INITIAL______________
I HAVE READ AND UNDERSTOOD THE ASSUMPTION OF RISK, WAIVER OF LIABILITY, AND MEDICAL RELEASE FORM.
I CONSENT TO TREATMENT AND I AM EXECUTING THIS DOCUMENT VOLUNTARILY AND WITH FULL KNOWLEDGE
OF ITS SIGNIFICANCE. SIGNING THIS RELEASE WAIVES LIABILITY AND RELEASES ANY RIGHT TO SUE OR MAKE
CLAIMS AGAINST UPSCALE ATHLETICS, LLC, OWNERS, AND EMPLOYEES FOR ANY INJURIES OR ALLEGED LIABILITIES.
WITH THE DANGERS OF THIS SPORT, I AM SIGNING THIS KNOWING AND VOLUNTARLY OF ALL AND ANY RISKS OF
INJURY. I WILL NOT HOLD UPSCALE ATHLETICS, LLC, OWNERS, AND EMPLOYEES NEGLIGENT OF ANY LIABILTY,
DAMAGES, CAUSES OF ACTION, DEBTS, CLAIMS, OR DEMANDS WHATSOEVER WHICH MAY ARISE WITH
PARTICIPATING IN ANY ACTIVITIES AND PROGRAMS OF UPSCALE ATHLETICS, LLC.
INITIAL_____________
Athlete’s name:________________________
Date_______________________
Athlete’s name:________________________
Date_______________________
Signature of Parent/Guardian:_____________________________
Date ________________________
*PARENTS PLEASE INITIAL AT THE APPROPRIATE PLACES ON THIS DOCUMENT. THANK YOU.