Waiver of Liability

This form is for athletes who are not registered in our Jackrabbit parent portal. This form must be completed before each class, event, or activity offered by Wicked Extreme Athletics in order for your athlete to participate.

Athlete Information

Athlete First Name

Athlete Last Name

Athlete Date of Birth

Month

Day

Year

The athlete listed above is medically cleared and able to participate in athletic activities such as cheerleading, tumbling, stunting, dancing, and jumping.

Yes

List all Allergies and Medications

Insurance Carrier

Insurance Policy Holder

Insurance Policy Number

General Policies

To help maintain a safe, organized, and positive environment for all participants, the following rules apply to all athletes, parents, guardians, spectators, and visitors.

Parking is only permitted across the parking lot from the building or directly in front of Unit #11 in designated Wicked Extreme Athletics parking areas. Parking in front of garage doors, neighboring businesses, or restricted areas is prohibited.

Only registered participants actively enrolled in a class, lesson, practice, camp, clinic, team activity, or open gym may enter the training area.

Parents, guardians, siblings, friends, and guests must remain in designated viewing areas unless otherwise authorized by staff.

Wicked Extreme Athletics reserves the right to restrict or close viewing areas at any time.

Food, gum, and drinks are prohibited on training surfaces and equipment.

Equipment may only be used under the supervision and direction of a Wicked Extreme Athletics coach or instructor.

Participants may not attempt new skills, stunts, tumbling passes, or progressions without direct coach instruction and supervision.

All injuries, illnesses, medical concerns, or participation restrictions must be disclosed prior to participation.

Participation fees are due in advance of services rendered and are subject to the applicable registration, payment, refund, attendance, and program policies of Wicked Extreme Athletics.

Parent/Guardian Information

Guardian First Name

Guardian Last Name

Guardian Email

Guardian Phone Number

I declare that the info I’ve provided is accurate and complete.

If I cannot be reached in an emergency, I hereby give permission for a physician to give emergency care that is deemed advisable for the welfare of my above named child.

Assumption of Risk, Release of Liability, Medical Authorization, Media Release, and Policy Acknowledgement

ASSUMPTION OF RISK
I understand and acknowledge that participation in cheerleading, tumbling, stunting, gymnastics, strength and conditioning activities, camps, clinics, open gyms, private lessons, team practices, competitions, performances, travel activities, spectator activities, and use of the facilities and equipment of Wicked Extreme Athletics involves inherent and significant risks that cannot be eliminated regardless of the level of care exercised by coaches, instructors, staff, volunteers, independent contractors, or participants.
These risks include, but are not limited to, slips, trips, falls, collisions, contact with equipment or other participants, sprains, strains, fractures, dislocations, concussions, head injuries, neck injuries, spinal injuries, paralysis, emotional distress, communicable illnesses, permanent disability, property damage, and death.
I voluntarily and knowingly assume all risks associated with participation in activities conducted by Wicked Extreme Athletics, whether such risks are known or unknown, foreseeable or unforeseeable, and whether occurring on or off the premises of Wicked Extreme Athletics.
PHYSICAL CONDITION & MEDICAL DISCLOSURE
I represent that I, or my minor child, am physically capable of participating in the activities offered by Wicked Extreme Athletics.
I agree to disclose any injury, illness, allergy, medical condition, physical limitation, restriction, or other circumstance that may affect safe participation. I further acknowledge an ongoing duty to notify Wicked Extreme Athletics of any changes in physical condition, injury status, medical restrictions, or health concerns that may affect participation.
I understand that failure to disclose relevant medical information may increase the risk of injury and may limit the ability of staff to respond appropriately in the event of an emergency.
RELEASE OF LIABILITY & COVENANT NOT TO SUE
To the fullest extent permitted by law, I voluntarily release, waive, discharge, hold harmless, and covenant not to sue NLC Athletics, LLC d.b.a. Wicked Extreme Athletics, its owners, members, managers, employees, independent contractors, coaches, instructors, volunteers, agents, representatives, successors, and assigns (collectively, the "Released Parties") from any and all claims, demands, causes of action, liabilities, damages, losses, costs, expenses, or judgments arising out of or related to participation in activities, attendance at events, observation of activities, travel, or use of facilities and equipment, including claims allegedly arising from the negligence of any Released Party, except where prohibited by applicable law.
INDEMNIFICATION
I agree to indemnify, defend, and hold harmless the Released Parties from and against any claims, demands, liabilities, damages, losses, costs, expenses, or attorney's fees arising out of my actions, my child's actions, or any breach of this agreement.
INSURANCE & FINANCIAL RESPONSIBILITY
I acknowledge that Wicked Extreme Athletics does not provide medical, health, accident, disability, or liability insurance coverage for participants.
I certify that I maintain adequate insurance coverage or otherwise accept full financial responsibility for any injury, illness, medical treatment, hospitalization, emergency transportation, rehabilitation, property damage, or related expense incurred as a result of participation.
EMERGENCY MEDICAL AUTHORIZATION
In the event of an injury, illness, accident, or medical emergency involving myself or my minor child, I authorize Wicked Extreme Athletics, its coaches, instructors, staff, agents, and representatives to obtain emergency medical treatment deemed reasonably necessary under the circumstances if a parent, guardian, or emergency contact cannot be reached.
I understand that all associated medical expenses remain my sole responsibility.
PHOTO, VIDEO & MEDIA RELEASE
I grant Wicked Extreme Athletics the irrevocable right and permission to photograph, videotape, livestream, record, reproduce, publish, distribute, display, and otherwise use images, recordings, likenesses, names, performances, and appearances of myself or my minor child for educational, promotional, advertising, marketing, social media, website, fundraising, and other lawful business purposes without compensation, notification, or further approval.
I understand and agree that all such media shall remain the property of Wicked Extreme Athletics.
POLICY ACKNOWLEDGMENT
I acknowledge that participation in activities offered by Wicked Extreme Athletics is subject to all applicable policies, procedures, handbooks, registration agreements, attendance requirements, safety rules, codes of conduct, payment policies, travel policies, and program guidelines, as amended from time to time.
I agree to comply with such policies and understand that failure to do so may result in suspension or removal from activities without refund.
PERSONAL PROPERTY
I understand that Wicked Extreme Athletics is not responsible for lost, stolen, or damaged personal property brought onto its premises or to competitions, events, hotels, travel activities, or other program-related locations.
GOVERNING LAW & SEVERABILITY
This agreement shall be governed by the laws of the Commonwealth of Massachusetts. If any provision of this agreement is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.
ACKNOWLEDGMENT OF UNDERSTANDING

I acknowledge that I have carefully read this agreement, fully understand its contents, understand that I am giving up substantial legal rights, including the right to sue, and agree to these terms voluntarily and without inducement.

I understand that this agreement is intended to be binding upon me, my child, my spouse, heirs, personal representatives, executors, administrators, successors, and assigns.

Signature

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Date of Signature