Text Box: Registration Form   Parent’s First Name:______________  Parent’s Last Name:_________________   Address:________________________  City:_______________  Zip:__________   Home Phone:_______________  Cell Phone:_______________  Email:_____________________________   Child’s First Name:____________  Child’s Last Name:______________  DOB:___/___/___  Male / Female   Child’s First Name:____________  Child’s Last Name:______________   DOB:___/___/___  Male / Female   Child’s First Name:____________  Child’s Last Name:______________   DOB:___/___/___  Male / Female     Text Box: RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (“AGREEMENT”)   In consideration of participating in activities at Extreme Indoor Sports and/or Southern Illinois Gymnastics Academy, Inc., I represent that I understand the nature of this activity and that I am qualified, in good health and in proper physical condition to participate in such activity.  I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the activity.  I fully understand that this activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the “releasees” named below, and that there may be other risks either not known to me or not readily foreseeable at this time; and 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 the Activity.   I herby release, discharge and covenant not to sue Extreme Indoor Sports and/or Southern Illinois Gymnastics Academy, Inc., its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my 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, which any may incur as the result of such claim   I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.   I understand that in the event of an injury, the medical policy supplied by Extreme Indoor Sports and/or Southern Illinois Gymnastics Academy, Inc., is a secondary policy with a $100 deductible paid by me.   ____________________________________                                             Date:_______________ Signature of Participant or Parent if a minor   PARENTAL CONSENT   AND I, the minor’s parent and/or legal guardian, understand the nature of the above referenced activities and the Minor’s experience and capabilities and believe the minor to be qualified to participate in such activity.  I herby Release, discharge, covenant not to sue and  AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses or damages on the minor’s account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any Releasees may incur as the result of any such claim.   I further understand that if I enter the facility, I do so at my own risk.  I understand that the facility has flooring with uneven surfaces.   I also understand, that I am not allowed on any gymnastics or bounce equipment.   __________________________________                                         Date:________________  Printed name of Parent or Legal Guardian   __________________________________   Signature of Parent or Legal Guardian     Text Box: How did you hear about us? _____________________________________________________________