Parent/Guardian Name

Participant Name

Participant Date of Birth

Class
—Please choose an option—optgroup-Senior CoedFridays 7pm-7:55pm (cost $300 HST included)endoptgroupoptgroup-Junior CoedSaturdays 1:40pm-2:25pm (cost $300 HST included)endoptgroupoptgroup-Preschoolersendoptgroup

Street Address

City/Town

Province
—Please choose an option—AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon

Postal Code

Phone

Your email

Your message (optional)

Consent Form

DISCLAIMER: Listowel Gymnastics Club (“Gymnastics Club”) 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 or teams (the “activity”) at Gymnastics Club for any reason whatsoever,
including ordinary negligence on the part of Gymnastics Club, its members, managers, agents, or employees

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 injury, 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.

Knowing and understanding the risks involved with participation in the activity, 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.

WAIVER: In consideration for my/minor’s participation in the activity, I hereby waive all claims or causes of action,
including ordinary negligence, against Gymnastics Club, its managers and members, and any of
their employees, teachers, coaches, or agents, arising out of my/minor’s participation in the activity wherever, whenever or
however the same may occur.

I understand that this waiver is intended to be as broad and as inclusive as permitted by the laws of the Province of Ontario
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 within the Province of Ontario.

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 Gymnastics Club 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 Gymnastics Club. I authorize Gymnastics Club 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 Gymnastics Club 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.

Signature:

After registering administration will email you an invoice. Your spot is only secure when the payment is received (etransfer or cash)