I understand that if I do not pay my bill in full I will be unable to participate in the New York Icons Activity. I understand that if I arrive to a New York Icons Class, Clinic, or Lessons and my bill is not paid in full, I will be asked to sit down and/or leave.

MEDICAL RELEASE AND LIABILITY WAIVER

Medical Release and Liability Waiver

I, certify that ________________________________________ is physically capable and able to fulfill requirements needed to participate in all aspects of the NEW YORK ICONS, INC (hereinafter referred to as “ICONS”) program and hereby give consent for him/her to participate in all aspects of the ICONS’s program. I Hereby release, discharge, hold harmless, covenant to indemnify and not to sue ICONS, it’s directors, officers, employees, coaches, volunteers, managers, agents, sponsors, shareholders, and any associated personnel, from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on behalf of the participant as a result of participation in ICONS program(s), including any event sponsored or sanctioned by ICONS, and/or travel to and from such activities. This release includes any claims of negligence, dangerous condition, latent defect, premises liability, code violation, negligent security, failure to warn, vicarious liability, negligent hiring, negligent supervision, negligent maintenance, or improper/dangerous equipment; it is intended to be as broad as is permissible under New York State Law.

Statement of Hazards of Participating in Athletic/Cheerleading/Tumbling

I, the undersigned participant and parent/legal guardian of the above listed minor (if participant is under the age of 18) acknowledge and fully understand that each participant will be engaging in activities that involve serious risk of injury, including but not limited to, death, serious neck, head and spinal injuries which may result in complete or partial paralysis; brain damage; serious injury to virtually all internal organs; muscular skeletal system; and serious injury or impairment to other aspects of the body , general health and well-being and any other unknown risks not reasonably foreseeable at this time. I assume all the foregoing risk and accept financial responsibility for the damages following any such injury.

Medical Treatment Release

If a medical emergency should arise during my child’s participation with NEW YORK ICONS, INC (hereinafter referred to as “ICONS”) at a time when I am not

personally present so as to be consulted regarding his/her care; I hereby authorize any agent of ICONS, on my behalf to take whatever measures are necessary to ensure that he/she is provided with any emergency medical treatment including hospitalization, which ICONS deems advisable in order to protect his/her health and well-being and I agree to be financially responsible for the cost of such assistance and/or treatment.

In addition, I give New York Icons, Inc. permission to film, photograph or videotape the above athlete for any reproductions, movies, televised events, or promotional print associated or in any way connected to New York Icons, Inc.

I have read and understand the registration form and agree to all terms as stated above. I also attest that all information given on this form is factual.

The following statements are recommended for communicating assumption of risk and releasing liability. You should contact your legal counsel to develop, present and collect consent for participation in your virtual training. By you or your child participating in this or any Virtual Practice and Workout:1. You agree, represent, and warrant that:•You are in a safe space, free of obstructions•You are on a safe training surface•You are wearing the proper attire to do the workout•You are working out at your own risk, and if you feel uncomfortable doing any activity, you have the right to opt out2. You further agree that the Liability Release you executed prior to joining New York Icons shall extend and apply to this Virtual Practices and Workouts service, including but not limited to limitation of liability, indemnification, and assumption of risk.3. In the event the participant is a minor, you, as the parent or legal guardian, agree to the above on behalf of yourself and your minor child. You further agree that you will observe and monitor your minor child during the course of the activity.

Programs

Victor Cheer Tumbling Session

SEASON 7 REGISTRATION

Virtual Flyer Class

Brockport Cheer Tumbling Session

BE AN ICON CLINICS

Fairport Classes

Rochester Classes

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