RELEASE, WAIVER AND CONSENT
As a parent or legal guardian of
, I give my consent for him / her to participate in the programs at Bianka Panova Sports and Arts Academy (“BPSAA”).
I fully understand that participation in physical exercise involving gymnastics and dance carry a risk of serious
bodily injury due to the heights and motions involved. These injuries may include muscle strains and tears. I agree
that the above named minor is voluntarily participating in these activities and that I am fully aware of the risks
involved and the possibility of injury that might result.
As BPSAA will make no recommendation whether a child is physically fit to engage in any exercise activity, I have evaluated
the experience and capabilities of the above named minor and believe that he/she is qualified to participate in
the activity. I agree to provide to BPSAA a physician's statement describing any physical condition which could
limit this child’s participation prior to commencement of activities under this program
As a parent or legal guardian, I agree to provide health insurance for the minor child or guarantee payment of any
medical expenses incurred as a result of training, performing, or participation in activities run by BPSAA.
I understand that in my absence BPSAA does not assume any responsibility for the care, custody, condition, health or
wellbeing of my child, and has no responsibilities with respect to the safety or adequacy of the transportation
of the child to or from the facility.
In consideration for allowing the above named minor child to participate in activities with BPSAA, I waive any and
all rights or causes of action against BPSAA, and its administrators, managers, agents, officers, employees, volunteers,
contractors, other participants and owners and lessors of the premises where the activity is being conducted (collectively,
“Releases”), for any injuries or other damages suffered by my child or myself while present at the facility or
under the supervision or control of BPSAA. It is my intent to release all Releases from liability for future ordinary
negligent conduct. I intend this waiver and release to be as broad and inclusive as permitted by the law of the
State of California, and agree that if any portion is found invalid, the remainder will continue in full legal
force and effect.
CONSENT FOR TREATMENT OF A MINOR
I fully understand that BPSAA staff members are not physicians or medical practitioners of any kind. With the above
in mind, I hereby grant permission for the staff of BPSAA, if deemed necessary by them, to render first aid and
to seek medical assistance, including summoning an ambulance, on behalf of the above named participant in the event
of any injury or illness. I acknowledge that any costs of medical care provided or emergency transportation, are
my sole responsibility.
USE OF LIKENESS
I hereby grant BPSAA permission and right to use, reproduce and display the above-named child’s name and likeness in
conjunction with the promotion of the activities of BPSAA. Such permission and consent specifically extends to
the display of the child’s name and likeness in marketing and promotional materials, including videos. I hereby
release BPSAA from and against (i) any liability based on any right which I have or may have by virtue of any such
use of the name and likeness, or as a result of the exhibition or display of the name and likeness; and (ii) any
claim for consideration or compensation for use of such name and likeness or the rights granted hereunder.
I recognize and acknowledge that during the course of instruction, in order to achieve a proper body placement and
correct training exercises, and to improve safety, the instructor assigned to the above child may touch the child
while performing a “spot”. A “spot” is the appropriate method to correct body alignment and maintain safety in
the sports of gymnastics, dance, and tumbling, and is recognized as proper technique and practice.
This Release, Waiver and Consent has been read by me, completely understood and signed voluntarily to confirm that I expressly
agree with the above statements. I am 18 years of age or older.