Achieve Fitness Waiver Form ACHIEVE FITNESS WAIVER 3460 South Fairplay Way Aurora, CO 80014 | 720-330-2200 | FrontDesk@AchieveGymnastics.com Applicant Name*Please enter the full name of the person that will be participating in activities at Achieve Gymnastics. First Last Waiver Activity*For our filing, this waiver must be renewed every 12 months and is for the selected program. Achieve Fitness Program ACKNOWLEDGEMENT OF RISK: I recognize that severe injuries, including permanent paralysis or death, can occur in sports or activities involving height, physical exertion or motion; those activities include but are not limited to gymnastics, tumbling, trampoline, movement education, dance, and physical fitness training. I also realize that I will/could be performing and training on all gymnastics events plus various training devices, including trampoline, cardio and weight lifting equipment. I certify that I have consulted a physician, to the extent that I deem appropriate, concerning my participation in these activities. I represent to DBA Sports, Inc. | Achieve Gymnastics (DBA | AG), that I am medically fit to participate. I am also aware that participation in Achieve Fitness, day camps, open gym and competition involves transportation to and from such events and that such transportation could result in injury or death in a vehicular accident. I furthermore recognize that due to increased movement, exercise and physical exertion, and aggressive pursuit of these sports and activities carries a higher degree of risk of catastrophic injury than do the recreational versions.CONSENT AND ASSUMPTION OF RISK: Being fully aware of these dangers, I hereby give consent to participate in any and all DBA | AG programs and activities for which I am registered or sign up for, and I ACCEPT ALL RISKS associated with this participation. WAIVER AND RELEASE: In consideration for my participation, I hereby, for myself and our respective heirs and successors, PROMISE NOT TO SUE AND FOREVER RELEASE AND DISCHARGE DBA | AG, its officers, directors, shareholders, employees, contractors, teachers, coaches and volunteers from all liability resulting from damages or injuries incurred as a result of participation in DBA | AG programs, including those resulting from acts of negligence. I understand that DBA | AG has relied upon this agreement in determining the extent of insurance coverage to be obtained and that in the absence of this Release, DBA | AG would charge considerably higher fees to participants.CONSENT TO MEDICAL TREATMENT: In the event of an accident or emergency, I hereby authorize DBA | AG and its representatives, including its employees, contractors, teachers, coaches, and volunteers, to render first aid to me to the extent they deem appropriate. I further authorize DBA | AG and its representatives to transport or arrange for transportation by ambulance, if DBA | AG deems it appropriate, of me to a hospital or any other medical or dental treatment facility. Additionally, I hereby agree to be personally responsible for payment of all medical and dental expenses, including transportation, which may be incurred by myself as a result of any injury sustained while participating at or for DBA | AG, including future medical and dental expenses related to such injury.PHOTO RELEASE: I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for my or my child(ren)’s participation, I grant permission for my or my child(ren)’s likeness to be used in DBA | AG publicity or advertising.Signature*I have read and understand this ACKNOWLEDGEMENT OF RISK, CONSENT AND ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, CONSENT OF MEDICAL TREATMENT and PHOTO RELEASE. My signature below indicates my voluntary agreement with the terms set forth above.