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TATIANA GUTSU GYMNASTICS ACADEMY

BIRTHDAY PARTY & GUEST PARTICIPATION WAIVER

Welcome to TGGA!

We're excited to celebrate with you! The safety and well-being of every child are our priorities.

Please complete this form before your child participates in any gymnastics activities, games, or open-gym activities at our facility.

1. PARTICIPANT INFORMATION

Child's Full Name

Child's Date of Birth

Birthday Child / Party Host Name

Party Date

Parent / Legal Guardian Full Name

Parent / Guardian Phone Number

Parent / Guardian Email

2. EMERGENCY & MEDICAL INFORMATION

Is the emergency contact the same as the parent/guardian?

A
B

Emergency Contact Name

Emergency Contact Phone Number

Does your child have any allergies, medical conditions, physical limitations, or injuries TGGA should be aware of?

A
B

3. ASSUMPTION OF RISK & LIABILITY ACKNOWLEDGMENT

I understand that gymnastics, tumbling, jumping, climbing, physical games, and recreational activities involve inherent risks.

These risks may include falls, collisions, sprains, fractures, head injuries, concussions, and other serious injuries.

I understand that even with supervision, safety rules, and appropriate equipment, injuries may occur.

I voluntarily authorize my child to participate in the birthday party's permitted physical activities at Tatiana Gutsu Gymnastics Academy (TGGA).

I acknowledge and voluntarily accept the inherent risks associated with these activities.

To the fullest extent permitted by applicable Michigan law, I agree to release TGGA, its owners, employees, coaches, and representatives from claims arising solely from the inherent risks of the activities. This provision does not release any party from liability that cannot legally be waived.

I have read and understand the assumption of risk and liability acknowledgment.

4. CONCUSSION AWARENESS

I understand that a concussion is a brain injury that may occur following a bump, blow, or jolt to the head or body.

Possible symptoms include headaches, dizziness, confusion, nausea, balance difficulties, and changes in behavior.

I understand that:
- My child must immediately stop participating if a concussion is suspected.
- I will be notified if my child sustains a suspected head injury.
- My child may not resume gymnastics activities until the applicable medical clearance requirements are satisfied.
- Concussion symptoms may not appear immediately.

I acknowledge that I have received and reviewed the concussion safety information provided by TGGA.

5. EMERGENCY MEDICAL AUTHORIZATION

In the event of an injury or medical emergency, I authorize TGGA staff to contact emergency medical services and arrange necessary emergency assistance when I cannot be reached promptly.

I understand that I am responsible for applicable medical expenses.

I understand and authorize emergency assistance as described above.

6. PARTICIPATION & SAFETY RULES

I understand that my child must follow all gym safety rules and instructions provided by TGGA staff. Participation may be restricted or discontinued if a child's behavior creates a safety risk.

I agree to TGGA's participation and safety requirements.

7. PARENT / GUARDIAN CONSENT & SIGNATURE

I certify that I am the parent or legal guardian of the participant named above. I have read and understand the information in this form and voluntarily authorize my child's participation.

Parent / Guardian Electronic Signature

Sign your name here

Date

Tatiana Gutsu Gymnastics Academy
24723 Crestview
Farmington Hills, MI 48335
The Power Is in YOU!