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Assumption of Risk, Waiver of Liability, Medical Authorization

I recognize that severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, those activities including but not limited to gymnastics, tumbling, trampoline, martial arts, dance, cheerleading, ball sports, swimming and diving. In addition I recognize that swimming or any activity in or around water can result in brain damage or drowning. I am also aware that participation in day camps involves transportation to and from field trips and such transportation could cause injury or death in a vehicular accident. Being fully aware of these dangers, I hereby give consent for my children to participate in any and all Ekistics, Inc., dba Powerplay programs and activities and I ACCEPT ALL RISKS associated with this participation. In consideration for my or my children's participation I hereby, for myself and my children and our respective heirs and successors, COVENANT NOT TO SUE and FOREVER RELEASE Powerplay, its officers, directors, shareholders, employees, contractors and volunteers from all liability resulting in damages or injuries incurred as a result of pai1icipation including those resulting from acts of negligence. In the event ofan accident or emergency I hereby authorize my child to be transported to a hospital for medical treatment and I hold Powerplay and its' representatives harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by myself or my children as a result of any injury sustained while participating at or for Powerplay. I have read and understand this ASSUMPTION OF RISK, WAIVER OF LIABILITY and MEDICAL AUTHORIZATION and I Voluntarily affix my name in agreement. * By signing below, I also give Powerplay permission to both take and use any photos taken for marketing publications without any compensation to me. I can opt out clearly stating so on this form.

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Sign and Submit

Submitting this application and signing the waiver form, confirms that you have read and agree to all the terms outlined in our registration agreement. Your payment affirms this statement.