RELEASE AND WAIVER, MEDICAL FORM                              7/2006 I/We _______________________ being the parent(s) or legal guardian(s) of ________________ do hereby give permission for my/our child(s)/ward to participate in all activities with Diamond Gymnastics & Dance Academy. In consideration for membership in Diamond Gymnastics & Dance Academy or participation in Diamond Gymnastics & Dance Academy classes, events, and activities, we agree to be bound by each of the following: 1.        Eligibility: We agree to comply with the rules of Diamond Gymnastics & Dance Academy.  We understand that gymnastics involves certain activities in a very unique environment and as such, carries a risk of physical injury.  We understand that no matter how careful the students and instructors are no matter how many spotters are used and no matter what landing surface exists the risk of injury cannot be eliminated.  The risk of injuries include but are not limited to: minor  injuries ,such as bruises, cuts, twisted/sprained ankles: wrist, and more serious injuries such as muscle tears/pulls, dislocations, fractures, permanent paralysis and even death from improper landings and/or falls on the head, neck and back. 2.        Readiness to Participate: My child/ward will only participate in those Diamond Gymnastics & Dance Academy classes, events, competition, and activities for which we believe he/she is physically and psychologically prepared.  Prior to participation he/she will have practiced exercises and will perform only those exercises which he/she has accomplished to the degree of confidence necessary to assure he/she can perform them by herself or himself and without injury. 3.        Medical Attention: I/We hereby give my/our consent to Diamond Gymnastics & Dance Academy and/or the host organization to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of participation.  We fully understand that Diamond Gymnastics & Dance Academy staff members are not physicians or medical practitioners of any kind.  With the above in mind, we hereby release any injury or illness, and if deemed necessary by the Diamond Gymnastics & Dance Academy staff to call a doctor and to seek medical help, including transportation by a Diamond Gymnastics & Dance Academy staff member and or its representatives, whether paid or volunteer to any health care facility or hospital, or the calling of any ambulance for said child should Diamond Gymnastics & Dance Academy staff deem that it be necessary. 4.        Waiver and Release:  We are fully aware of and associate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated with participation in gymnastic activities and events.  With the above in mind, and being fully aware of the risks and possibility of injury involved, I/We consent to have my/.our child of children participate in the programs offered by Diamond Gymnastics & Dance Academy I, my spouse, my executors and other representatives waive and release all rights and claims for damages that we or my child or children may have against the Diamond Gymnastics & Dance Academy and/or its representatives whether paid or volunteer. 5.        I/We further agree that Diamond Gymnastics & Dance Academy and the sponsor of any Diamond Gymnastics & Dance Academy event, along with the employee, agents, officers and directors of these organizations shall not be liable for any losses or damages occurring as a result of participation in the event, except where such loss or damage is the result of the intentional or reckless conduct of one of the organizations or individuals identified above.  I/We agree to indemnify and hold harmless Diamond gymnastics & Dance Academy it’s owners, officers, directors, staff, employees and guest instructors from any and all liability in the event that my/our should become injured while on the premises at Diamond Gymnastics & Dance Academy or  while involved in a Diamond Gymnastics & Dance Academy function. 6.        I/We also represent that I/We now have and will continue to provide proper hospitalization, health and accident insurance coverage which I/We consider adequate for both my/our child’s protection and my/our own protection. 7.        I/We also understand that it is the parent’s responsibility to warn the child about the dangers of gymnastics and injury.  The parent should warn the child according to what the parent feels is appropriate.   Diamond Gymnastics & Dance Academy will only warn the child through “Safety Messages” and our teaching style and progressions. We acknowledge that we have been given a copy of the Diamond Gymnastics & Dance Academy Procedures and Policies.  A staff member of Diamond Gymnastics & Dance Academy has reviewed the foregoing Release and Waiver form to me, and I/We have been asked if we would like a copy given of the same. Signature of Athlete (s) (if 18 yrs. or older) For any athlete who is not yet 18 years old: As a legal parent or guardian of this athlete, I/We hereby verify by my signature below that I/We fully understand and accept each of the above conditions for permitting my child to participate in classes, events, competitions and activities conducted by Diamond Gymnastics & Dance Academy.  By execution hereof, I/We do further bind myself  my spouse and my child. Printed name of Parent/Guardian Signature of Parent/Guardian  MEDICAL HISTORY  To be completed by parent/ legal guardian or by the student if over 18 yrs of age.  Check the appropriate space for “YES” or “NO”  Student 1:                       YES   NO     Is the student currently under any medication? If YES, please list:  __     __        ______________________________________________________________  __     __        Does the student have any allergies to food and/or drugs? If so, please list:                    ______________________________________________________________             __     __       Has the participating student ever been advised by a physician not to participate                      in any athletic activity ?  If yes, please provide a medical release form from your                      physician.  __     __       Has the participating student ever had surgery?  If so, please explain:                   ______________________________________________________________              Check only the appropriate box below if the participating student has any history of the following: __  Asthma    __ High Blood Pressure   __ Broken Bones            __ Hepatitis        __ Hypoglycemia __ Frequent Headaches    __ Neck/Back injury    __ Diabetes     __ Chronic back pain __ Frequent nose bleeds   __ Irregular heart beat  Please explain any physical, mental or medical condition not listed above in the space below: