EPIC Kidz
RELEASE AND WAIVER OF LIABILITY
My child has authorization to participate in the C and M Fitness, LLC dba Epic Kidz, enrichment classes that will take place on their school’s campus following dismissal. C and M Fitness, LLC dba EPIC Kidz epickidzfl.com RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OR RISK, AND INDEMNITY AGREEMENT In consideration of participating in St. Luke School, Oviedo, St. Luke Preschool, Oviedo, and or its affiliates classes or special events, I represent that I understand the nature of this activity and that I am qualified, in good health, and in proper physical condition to participate in such activity, I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the activity. I fully understand that this activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the event takes place, or the negligence of the participant name below and that there may be other risks either not known to me or not readily foreseeable at this time. I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation in the activity. I hereby, release, discharge, and covenant not to sue C and M Fitness, LLC dba EPIC Kidz and or its affiliates, its respective administrators, directors, agents, offices, contractors, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and leasers of premises on which the activity takes place, each considered one of the releasers herein from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise, including negligent rescue operation and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasers, I will indemnify, save, and hold harmless each of the Releasers from any loss, liability, damage, or cost, which any may incur as the result of such claim. If claim is filed, I understand it must be filed in the county the incident occurred.
PARENTAL CONSENT I, THE MINORS PARENT AND OR LEGAL GUARDIAN, understand the nature of the above referenced activities and the Minors experience and capabilities and believe the minor to be qualified to participate in such activity. I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights on behalf of my children, myself and any chaperones participating on my behalf, by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.
I give my permission to C and M Fitness, LLC dba EPIC Kidz and or its affiliates to use, without limitation of obligation, photographs, film footage, or tape recordings, which may include an individual’s image, family image and or voice for the purpose of promoting or advertising in, but not limited to, print and or social media.
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Name of Child(printed)
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Name of Parent/Guardian (printed)
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Signature of Parent/Guardian
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Consent and Release from Liability Certificate for Concussions
Concussion Information
Concussion is a brain injury. Concussions, as well as all other head injuries, are serious. They can be caused by a bump, a twist of the head, sudden deceleration or acceleration, a blow or jolt to the head, or by a blow to another part of the body with force transmitted to the head. You can’t see a concussion, and more than 90% of all concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. All concussions are potentially serious and, if not managed properly, may result in complications including brain damage and, in rare cases, even death. Even a “ding” or a bump on the head can be serious. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, your child should be immediately removed from play, evaluated by a medical professional and cleared by a medical doctor.
Signs and Symptoms of a Concussion:
Concussion symptoms may appear immediately after the injury or can take several days to appear. Studies have shown that it takes on average 10-14 days or longer for symptoms to resolve and, in rare cases or if the athlete has sustained multiple concussions, the symptoms can be prolonged. Signs and symptoms of concussion can include: (not all-inclusive)
• Vacant stare or seeing stars
• Lack of awareness of surroundings
• Emotions out of proportion to circumstances (inappropriate crying or anger)
• Headache or persistent headache, nausea, vomiting
• Altered vision
• Sensitivity to light or noise
• Delayed verbal and motor responses
• Disorientation, slurred or incoherent speech
• Dizziness, including light-headedness, vertigo(spinning) or loss of equilibrium (being off balance or swimming sensation) • Decreased coordination, reaction time
• Confusion and inability to focus attention
• Memory loss
• Sudden change in academic performance or drop in grades
• Irritability, depression, anxiety, sleep disturbances, easy fatiguability
• In rare cases, loss of consciousness
DANGERS if your child continues to play with a concussion or returns too soon:
Athletes with signs and symptoms of concussion should be removed from activity (play or practice) immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to sustaining another concussion. Athletes who sustain a second concussion before the symptoms of the first concussion have resolved and the brain has had a chance to heal are at risk for prolonged concussion symptoms, permanent disability and even death (called “Second Impact Syndrome” where the brain swells uncontrollably). There is also evidence that multiple concussions can lead to long-term symptoms, including early dementia.
Steps to take if you suspect your child has suffered a concussion:
Any athlete suspected of suffering a concussion should be removed from the activity immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without written medical clearance from an appropriate health-care professional (AHCP).
In Florida, an appropriate health-care professional (AHCP) is defined as either a licensed physician (MD, as per Chapter 458, Florida Statutes), a licensed osteopathic physician (DO, as per Chapter 459, Florida Statutes). Close observation of the athlete should continue for several hours. You should also seek medical care and inform your child’s coach if you think that your child may have a concussion. Remember, it’s better to miss one game than to have your life changed forever. When in doubt, sit them out.
Return to play or practice:
Following physician evaluation, the return to activity process requires the athlete to be completely symptom free, after which time they would complete a step-wise protocol under the supervision of a licensed athletic trainer, coach or medical professional and then, receive written medical clearance of an AHCP.
For current and up-to-date information on concussions, visit http://www.cdc.gov/concussioninyouthsports/ or http://www.seeingstarsfoundation.org
Statement of Student Athlete Responsibility
Parents and students should be aware of preliminary evidence that suggests repeat concussions, and even hits that do not cause a symptomatic concussion, may lead to abnormal brain changes which can only be seen on autopsy (known as Chronic Traumatic Encephalopathy (CTE)). There have been case reports suggesting the development of Parkinson’s-like symptoms, Amyotrophic Lateral Sclerosis (ALS), severe traumatic brain injury, depression, and long-term memory issues that may be related to concussion history. Further research on this topic is needed before any conclusions can be drawn.
I, the undersigned, am the parent and/or legal guardian of the child/children I am registering. As the parent and/or legal guardian of the child/children I am registering, I understand and agree that participation in sports activities has inherent risk of personal injury for those participating. I agree that in allowing my child/children to participate that I, for myself and my child/children, assume all risks and hazards incidental to participation, including transportation to and from activities, and do hereby, for myself, all dependent children, my heirs, executors and administrator, waive, release, absolve, indemnify and agree to hold harmless Epic Kidz, and its representatives, sponsors, affiliated associations, organizers, officers, officials and participants for any and all damages and/or injuries suffered by myself or any child or other participant that I may register in connection with any activity with Epic Kidz. Also, I agree that myself and the person(s) registered for any activity with Epic Kidz will abide by all the rules and policies outlined in the local, state, and national as governing policies and rules by Epic Kidz.
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Name of Child (printed)
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Name of Parent/Guardian (printed)
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Signature of Parent/Guardian
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Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Epic Kidz Sports and Tumbling Programs has put in place preventative measures to reduce the spread of COVID-19; however, the Club cannot guarantee that you or your child will not become infected with COVID-19. Further, attending the Epic Kidz sports and tumbling could increase your risk and your child risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child and I may be exposed to or infected by COVID-19 by attending the Epic Kidz Sports and Tumbling and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Epic Kidz Sports and Tumbling may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Epic Kidz employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child may experience or incur in connection with my child attendance at Epic Kidz Sports and Tumbling or participation in Epic Kidz programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Epic Kidz, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Epic Kidz, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any after school and camp programs.
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Name of Child (printed)
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Name of Parent/Guardian (printed)
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Signature of Parent/Guardian
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