MEDICAL AUTHORIZATION AND LIABILITY RELEASE
XPLOSION CHEER & TUMBLING ATHLETICS LLC
d/b/a XPLOSION CHEER & TUMBLING
7011 Patton Park Rd
Lyles, TN 36098
(615) 337-7744
[email protected]
PARENT/GUARDIAN/CUSTODIAN’S RELEASE AND WAIVER OF LIABILITY AGREEMENT
WHEREAS, XPLOSION CHEER & TUMBLING ATHLETICS LLC, D/B/A XPLOSION CHEER &
TUMBLING (“Company”) is the owner and operator of a facility offering youth dance, tumbling and
cheerleading and ninja programs (the “Activity”), and is willing to permit the minor individual (the
“Child”) on whose behalf the parent/guardian/custodian is signing this Agreement to participate in the
Activity, upon the terms and conditions of this Agreement. All of the Activity shall take place on property
controlled by the Company. The location of the Activity shall be on property (the “Premises”) located at
7011 Patton Park Rd, Lyles, TN 36098. The Company and Participants signing this Agreement may be
collectively referred to as (the “Parties”).
In consideration for being provided the ability to participate in the Activity and enter the Premises, I,
signing below, hereby stipulate and agree on behalf of my minor child:
1. Scope of Application. This Release and Waiver of Liability Agreement applies to me, the parent or
legal guardian signing on behalf of my Child.
2. Use of Premises for Activity Only. I understand and agree that my Child may only use the Premises
for the Activity set forth in this Release and Waiver of Liability agreement. I further agree that my
Child is responsible for the proper use and care of the Premises and any of Company’s property
thereon, and that I will be liable for the replacement cost of any Company property/equipment which
is damaged, destroyed or lost by my Child.
3. Acknowledgement of Danger. I understand and acknowledge that the Activity my Child wants to
participate in is extremely strenuous. I recognize and understand these Services are not without
varying degrees of risk, which may include, but are not limited to the following: (1) PHYSICAL
INJURY AND/OR DEATH including minor injuries and major injuries such as
joint/shoulder/elbow/knee/back/foot injuries, broken bones, concussions, rhabdomyolysis,
musculoskeletal injuries, muscle strains, pull or tears, shin splint, heat exhaustion, cardiovascular
injuries, heart attack, stroke, and brain injuries, injuries from falling from heights during jumping and
climbing activities, impact injuries, and collision injuries; (2) exposure to, and sickness from,
infections viruses, bacteria and disease, including but not limited to, COVID-19; and (3) property
damage. I understand that the Premises may contain toys or other items that other children have
brought along with them, and I willingly accept the risk related to these objects being around and/or
in contact with my Child. I further acknowledge that any injury my Child may sustain while
participating in the Activity may be compounded by improper use or failure of equipment, a known or
unknown medical condition, negligent or delayed medical service, or negligent or delayed assistance
by the Company.
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4. Acceptance of Responsibility. I willingly assume full responsibility for any and all risks that I am
exposing my Child to as a result of my Child’s participation in any Activity in the Premises and
training program and accept full responsibility for any injury or death that may result from their
participation.
5. Use of Premises. I understand and agree that my minor may only use the Premises for the purposes
set forth in this Release and Waiver of Liability agreement or as provided for in the Premises. I
further agree that I am responsible for my minor child’s proper use and care of the Premises and any
of Company’s property thereon, and that I will be liable for the replacement cost of any Company
property which is damaged, destroyed or lost. I also agree that my minor child will clean up the
Premises after they are done using the Premises as permitted in this agreement and to restore the
Premises to the same condition in which it was provided to me. I acknowledge that the Company
makes no representation as to the condition of the Premises or the safety of any structures or
equipment that may be used at the Premises. I accept and my minor child shall use the Premises in its
“AS IS” condition. I acknowledge and agree that I am not relying upon any representation or
statement by the Company or the Company’s employees, agents, or representatives regarding this
agreement or the Premises, except to the extent such representations are expressly set forth in this
agreement.
6. Unattended Access: I recognize that my minor child may be attending the Premises and using the
Premises’s equipment at times when the Premises is unattended by Premises staff or other members.
7. Assumption of Risk. Understanding, acknowledging, and accepting all the risks and hazards
involved with the Services, I freely and voluntarily choose to allow my Child to participate, enter, and
use the Premises, and I, FOR MYSELF AND ON BEHALF OF MY CHILD, HEREBY
VOLUNTARILY AND EXPRESSLY AGREE TO ACCEPT AND ASSUME ALL RISK OF LOSS,
DAMAGES, THEFT, INJURY OR DEATH THAT MAY OCCUR TO MY CHILD OR THEIR
PROPERTY AS A RESULT OF OR INCIDENT TO MY CHILD’S PARTICIPATION IN THE
SERVICES, INCLUDING THE RISK THEY MAY BE INJURED BY THE ACTIONS,
OMISSIONS, REPRESENTATIONS OR NEGLIGENCE OF THE COMPANY, ITS OWNERS,
AGENTS, OFFICERS, PRINCIPALS, EMPLOYEES, INDEPENDENT CONTRACTORS,
VOLUNTEERS, OR ANY OTHER PERSON ASSOCIATED WITH COMPANY (“RELEASED
PARTIES”), OTHER PARTICIPANTS OR THIRD PARTIES WHILE PARTICIPATING IN THE
SERVICES OR FROM OR USING OR VISITING THE PREMISES. I understand and agree that
this Agreement will be binding on me, my spouse (or registered domestic partner), my guardians, the
executors or administrators of my estate, my heirs, my personal representatives, my assigns, my
successors in interest, my children, and any guardian ad litem for said children (collectively, the
“releasors”). I accept full and complete responsibility for the safety of myself, any guests, observers
or other individuals who I have invited to the Premises, and property we have brought to the
Premises, and I assume the risk of damage, theft, loss or injury caused by others to me, my guests and
our property. I also accept full and complete responsibility for the consequences of my Child taking
unreasonable risks while participating in the Services or using the Premises, including, without
limitation, attempting activities that my Child not qualified to perform safely, causing any other
participants/spectators an unreasonable risk of harm, or failing to follow correct safety procedures
when using the Premises and participating in the Services.
8. Physical Contact Acknowledgement. I understand that the Activity my Child will be participating
in involves physical contact between my Child, other participants, and those presenting Company. I
give permission for my Child to be touched in a professional manner by coaches and trainers
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representing the Company and recognize that they will have direct contact with my Child when doing
so. I acknowledge that it is my responsibility to notify Company if I am uncomfortable with this
physical contact with my Child and will work with Company to determine how my Child may
continue to participate in the Activity with no contact.
9. Publicity Release. For good and valuable consideration, the receipt of which is hereby
acknowledged, I hereby irrevocably grant to Company, the irrevocable, perpetual and unrestricted
(except as expressly set forth below) right and permission, to use and publish my Child’s appearance
(“publicity rights”) in any and all media now or hereafter known in connection with the Company, the
Services, including any goods or products, or any related activities to any of the foregoing (all such
medium in which the Publicity Rights are used shall be referred to as the “pictures”), for any
commercial purpose whatsoever, without royalty, payment, or any other compensation whatsoever to
me or my Child. For such use of the Publicity Rights and the Pictures, I understand and agree that I
and my Child will not be entitled to any compensation or consideration beyond my Child’s
participation in the Services. I further agree that the Company may edit, alter, digitize, synchronize,
reproduce or otherwise change the Pictures for any such purpose. I acknowledge that I and my Child
shall have no, and hereby expressly disclaim, any ownership, authorship or moral rights in the
Pictures or any part thereof.
10. Video Surveillance. I recognize the need for video surveillance on and about Premises for security
and productivity purposes. I recognize and agree that it is a condition of my Child’s participation at
the Company that I freely execute and agree to this video surveillance, including being personally
recorded pursuant to said video surveillance. I agree that the Released Parties may use any taping of
my Child’s image, voice or appearance at any time pursuant to said video surveillance at its discretion
in the ordinary course of its operations.
11. Audio/Visual Publicity Waiver. I agree to indemnify and hold harmless the Released Parties, its
agents, successors, and assigns, from any and all claims, demands, actions or causes of action,
liabilities, costs, dues, sanctions, fees, penalties, or expenses of any sort arising from the making of
such recordings of my Child and their lawful and appropriate use. I further acknowledge that the
Company exclusively owns all rights to these recordings regardless of the form in which they are
produced or used.
12. Copyrights. The rights granted to the Released Parties herein include, without limitation, all rights
of every nature whatsoever in connection with use of the Pictures, including without limitation all
copyrights (and any other intellectual property rights) therein and renewals and extensions thereof. I
acknowledge and agree that all copyrights and right of every other kind relating or pertaining to the
Pictures described above are the sole property of the Company and I and my Child have no claim to
the copyrights (or any other intellectual property rights) in the Pictures.
13. Responsibility for Personal Property. I acknowledge and agree that my Child is fully and solely
responsible for any of my Child’s property and personal belongings that he/she brings onto the
Premises or that he/she uses during the Activity, and that the Company will not be responsible for or
provide any security for his/her property and personal belongings.
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14. No Representations by Company. I acknowledge that Company makes no representation as to the
condition of the Premises or the safety of the Activity or any equipment either on the Premises or
used in the Activity. I accept, and my Child shall use, the Premises, and its equipment, in its “AS IS”
condition. I acknowledge and agree that I am not relying upon any representation or statement by the
Company or the Company’s employees, agents, sponsors, or representatives regarding this agreement
or the Premises or Activity, except to the extent such representations are expressly set forth in this
agreement.
15. Service Animals: I understand that only dogs trained as service animals, within the definition of the
Americans with Disabilities Act, to perform tasks or work for a person with a disability are permitted
as service animals.
(a) Service animals must be well-behaved and under control at all times. If the service animal is
not under control, or behaving inappropriately, I understand that Company may ask me to
leave. Inappropriate behavior includes showing aggression, being disruptive, or not being
housebroken. I understand that if the presence of the service animal poses a direct threat to the
health or safety of others that cannot be mitigated, I may be asked to remove the service animal
from the premises. I shall be liable for any damage or injury to any person or property caused
by such animal as a result of my negligence or failure to control or properly handle the service
animal. I will indemnify, defend, and hold harmless Company, and its owners, agents, officers,
principals, employees, independent contractors and volunteers for any damages, loss, expenses,
attorneys' fees, costs, judgments or liability which might accrue as the case may be, because of
the my negligence or failure to control or properly handle the service animal.
16. Consent to Medical Treatment. I understand that the Services that take place on the Premises may
not be supervised and that the Company does not provide medical services. I understand that certain
prescribed medications may exacerbate these physiological changes and create an even greater risk of
physical damage or death to my Child. In connection with any injury that my Child may sustain or
illness or other medical conditions that my Child may experience during their presence at the
Company, I authorize and consent for my Child to receive any emergency first aid, medication,
medical and/or surgical treatment deemed necessary by the attending personnel and/or the Released
Parties. I acknowledge that the Released Parties are under no obligation to provide such medical
treatment or services, and the Released Parties do not warrant or make any representation concerning
the adequacy or continuation of such medical services, nor can the Released Parties be deemed
responsible or held liable for any claims arising out of the provision of such medical services or the
failure to provide or to continue to provide such medical services. I further authorize the Released
Parties to execute on my behalf and my Child’s behalf any permission forms, consents or other
appropriate documents relating to medical attention and to act on my behalf if not able or
immediately available to do so and the same is urgent as determined in their sole discretion. I
ACKNOWLEDGE AND AGREE THAT EMERGENCY ASSISTANCE AND/OR TREATMENT
MAY BE RENDERED BY PERSONS WITH TRAINING OR EXPERIENCE WHICH MAY NOT
BE ADEQUATE FOR CERTAIN MEDICAL SITUATIONS AND/OR THE INJURIES
SUSTAINED BY MY CHILD, WHICH INJURIES MAY BE COMPOUNDED BY NEGLIGENT
FIRST AID OR EMERGENCY RESPONSE OF THE RELEASED PARTIES OR OTHER
INDIVIDUALS OR MEDICAL OR EMERGENCY PERSONNEL AND WAIVE ANY CLAIM IN
RESPECT THEREOF. I expressly acknowledge that if the Company is located some distance from
medical facilities, that such distance may exacerbate any injury or condition sustained by my Child. I
shall be responsible for all costs associated with such medical care and related transportation.
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17. Release from Liability and Waiver. In full consideration of the above mentioned risks and hazards
and in full consideration of the fact that I am willingly and voluntarily allowing my Child to
participate in the Services, I HEREBY WAIVE RELEASE AND FOREVER DISCHARGE ON MY
BEHALF INDIVIDUALLY, AND ON MY BEHALF AS THE PARENT AND/OR LEGAL
GUARDIAN OF MY CHILD, ANY AND ALL CLAIMS OR CAUSES OF ACTION, NOW
KNOWN OR HEREAFTER KNOWN IN ANY JURISDICTION THROUGHOUT THE WORLD,
AGAINST THE RELEASED PARTIES, INCLUDING, WITHOUT LIMITATION, ANY BODILY
INJURY OR DISABILITY, ILLNESS OR DISEASE, ACCIDENT, DEATH, FINANCIAL LOSS,
PROPERTY LOSS, DAMAGE, DESTRUCTION, DELAY, INCONVENIENCE OR OTHER
HARM OF WHATEVER NATURE THAT MAY BE DIRECTLY OR INDIRECTLY RELATED
TO, ARISING FROM OR SUSTAINED FROM MY CHILD’S PARTICIPATION IN THE
SERVICES AND/OR USE OF THE PREMISES OR ACTIVITIES RELATED THERETO,
NEGLIGENT FIRST AID OR EMERGENCY RESPONSE OF THE RELEASED PARTIES OR
OTHER NEGLIGENT ACT OR OMISSION OR BREACH OF ANY EXPRESS OR IMPLIED
WARRANTY OF ANY RELEASED PARTIES OR OTHERWISE, provided that nothing in this
Section shall be deemed to release any Released Party from liability arising from their own willful or
intentional injury to me or my property.
18. Indemnification: To the fullest extent permitted by law, I agree to indemnify, defend, and hold
harmless the Released Parties from and against any and all claims, actions, suits, proceedings, losses,
liabilities, penalties, fines, damages, costs, or expenses of any kind whatsoever (including, without
limitation, attorneys' fees and costs) incurred by or asserted against any of the Released Parties as a
result of my child’s use of the Company’s facilities, equipment, or services; my child’s breach of any
term, covenant, or condition of this Waiver or any rules or policies of the Company; any negligent or
willful act or omission of my child’s or my child’s guests while on the Company’s premises; any
injury, illness, or death sustained by my child or my child’s guests while using the Company's
facilities, equipment, or services, except to the extent directly caused by the Company’s gross
negligence or willful misconduct.
The indemnification obligations under this clause shall include, without limitation, all costs,
expenses, and liabilities incurred in connection with any claim, action, or proceeding brought with
respect to the matters indemnified hereunder, including all court costs and actual attorneys' fees
incurred. The Company shall promptly notify me of any claim or action subject to indemnification
and shall cooperate fully in the defense of such claim or action, at my expense. I shall have the right
to assume the defense of any claim or action subject to indemnification with counsel of its choice,
subject to the Company's approval, which shall not be unreasonably withheld. I shall not enter into
any settlement or compromise of a claim or action subject to indemnification without the Company’s
prior written consent, which shall not be unreasonably withheld. The indemnification obligations
under this clause shall survive the termination or expiration of my child’s membership or use of the
Company's facilities, equipment, or services, and shall continue to apply after my child reaches the
age of majority, including through the duration of any applicable statute of limitations or other legal
time period that was tolled or extended due to my child’s minority at the time of any injury, loss, or
the occurrence of any event giving rise to a claim.
19. Covenant Not to Sue. I agree, for myself, my Child, and all my heirs, not to sue the Released Parties
or initiate or assist in the prosecution of any claim for damages or cause of action against the
Released Parties which I, my Child, or my heirs may have as a result of any personal injury, death,
property damage, alleged discrimination, or for any other injury my Child may sustain while on or
using the Premises or while participating in the Activity.
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20. Transition. Upon reaching the age of majority or becoming an adult member of the Gym, my Child
assumes all rights, responsibilities, and liabilities associated with their participation in cheerleading
activities. The terms and conditions of this Agreement shall continue to apply to my Child in their
individual capacity. My Child, upon reaching the age of majority or becoming an adult member,
hereby agrees to sign a separate waiver acknowledging their understanding of the risks involved and
releasing the Gym, its staff, employees, and volunteers from any and all liability. This separate waiver
shall be signed within thirty (30) days of my Child reaching the age of majority or becoming an adult
member.
21. Waiver of Terms. No waiver of any term or right in this Release and Waiver of Liability agreement
shall be effective unless in writing, signed by an authorized representative of the waiving party. The
failure of any party to enforce any provision of this agreement shall not be construed as a waiver or
modification of such provision, or impairment of its right to enforce such provision or any other
provision of this agreement thereafter.
22. Survival. Any provision of this Release and Waiver of Liability agreement providing for
performance by either party after termination of this agreement shall survive such termination and
shall continue to be effective and enforceable.
23. Governing Law and Venue. This Release and Waiver of Liability agreement will be governed by
and interpreted in accordance with the laws of the State of Tennessee, without giving effect to the
principles of conflicts of law of such state. I agree that any action arising out of this Release and
Waiver of Liability agreement must be brought exclusively in any state or federal court located in
Hickman County, Tennessee.
24. Compliance with Laws. In the performance of the terms of this Release and Waiver of Liability
agreement and use of the Premises, the parties shall comply with all applicable federal, state, regional
and local laws, rules and regulations.
25. Severability. If any provision or portion of this Release and Waiver of Liability agreement shall be
held by a court of competent jurisdiction to be illegal, invalid, or unenforceable, the remaining
provisions or portions shall remain in full force and effect.
26. Entire Agreement; Modification; Binding Effect. This Agreement is the entire agreement between
the parties with respect to the subject matter hereof and supersedes any prior agreement or
communications between the parties, whether written, oral, electronic, or otherwise. No change,
modification, amendment, or addition of or to this agreement shall be valid unless in writing and
signed by authorized representatives of the parties. This agreement shall be binding upon and inure to
the benefit of the successors, assigns, and legal representatives of the parties.
I, THE PARENT/GUARDIAN/CUSTODIAN, OF THE MINOR CHILD HEREBY
ACKNOWLEDGE THAT I HAVE FULLY READ AND UNDERSTAND EACH OF THE
ABOVE PROVISIONS AND THAT I UNDERSTAND I AM GIVING UP SIGNIFICANT
LEGAL RIGHTS OF MINE AND MY CHILD’S, INCLUDING THE RIGHT TO SUE THE
COMPANY. I ACKNOWLEDGE THAT PRIOR TO SIGNING THIS AGREEMENT I HAD
THE OPPORTUNITY TO CONSULT WITH AN ATTORNEY TO REVIEW THIS
AGREEMENT. I AM AT LEAST EIGHTEEN (18) YEARS OF AGE AND FULLY
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COMPETENT, AND I EXECUTE THIS AGREEMENT VOLUNTARILY AND FOR
ADEQUATE CONSIDERATION INTENDING TO BE FULLY BOUND.
FURTHER, I ACKNOWLEDGE THAT MY CHILD WILL BE PARTICIPATING IN
ACTIVITIES AT THE COMPANY AND UNDERSTAND AND AGREE THAT, UNDER
TENNESSEE LAW, I MAY NOT BE ABLE TO WAIVE MY CHILD’S RIGHT TO BRING A
CLAIM FOR PERSONAL INJURY; HOWEVER, I VOLUNTARILY ASSUME ALL RISKS
OF PARTICIPATION ON BEHALF OF MY CHILD, INCLUDING, BUT NOT LIMITED TO,
BODILY INJURY, DISABILITY, DEATH, OR PROPERTY DAMAGE.
I ACKNOWLEDGE THAT ANY CLAIM MY CHILD MAY HAVE FOR PERSONAL
INJURY THAT ARISES FROM PARTICIPATION IN THE SERVICES IS PRESERVED
UNTIL MY CHILD REACHES THE AGE OF 18. THE STATUTE OF LIMITATIONS FOR
SUCH CLAIMS WILL BEGIN TO RUN ONLY UPON MY CHILD’S 18TH BIRTHDAY, IN
ACCORDANCE WITH TENNESSEE LAW.