Visitor Waiver/Release Form

STATE OF TEXAS                                                                   HARRIS COUNTY

     I fully understand that Rowland Interests L.P. staff members are not physicians or medical practitioners of any

kind. With the above in mind, I hereby release the Rowland Interests L.P. staff to render first aid to my child or

children in the event of any injury or illness, and if deemed necessary by the Rowland Interests L.P. staff to call our

doctor and to seek medical help, including transportation by a Rowland Interests L.P. staff member or its

representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance

for said child should the Rowland Interests L.P. staff deem this to be necessary. And;

     We the staff of Rowland Interests L.P. recognize our obligation to make our students and their parents aware of

the risks and hazards associated with the activities of gymnastics, trampoline, tumbling, cheerleading, and dance and

special events such as slumber parties and fun nights. Students may suffer injuries, possibly minor, serious, or

catastrophic in nature. Gymnastics, trampoline, tumbling, cheerleading, dance, and other activities performed under

one of the Rowland Interests L.P. programs can be dangerous and can lead to injury.

     Parents should make their children aware of the possibility of injury and encourage their children to follow all

the safety rules and the coaches' instructions. Rowland Interests L.P., its coaches, instructors, and other staff

members, will not accept responsibility for injuries sustained by any student during the course of any of the Rowland

Interests L.P. programs, or open workouts or in the case of any exhibition, competition, or clinic in which he or she

may participate while traveling to or from the event. With the above in mind, and being fully aware of the risks and

possibility on injury involved, I consent to have my child or children participate in the programs offered by Rowland

Interests L.P. I, my executors, or other representatives, waive and release all rights and claims for damages that I or

my child may have against Rowland Interests L.P. and/or its representatives whether paid or volunteer. I also affirm

that I now have and will continue to provide proper hospitalization health, and accident insurance coverage which I

consider adequate for both my child's protection and my own protection. I also understand that it is the parents'

responsibility to warn the child about the dangers of gymnastics, trampoline, tumbling, cheerleading, dance, or any

other Rowland Interests L.P. program and injury. The parent should warn the child according to what the parent feels

is appropriate. Rowland Interests L.P. will only warn the child through "Safety Messages" and our teaching style and

progressions.

Name of Visitor/Participant_____________________________________ Phone #____________________

Parent/Guardian Signature:_____________________________________ Date______________________

MEDICAL INFORMATION:                                        

List any physical or psychological handicaps, chronic ailments, or allergies:

_______________________________________________________________________________________

_______________________________________________________________________________________

PREFERRED PERSONAL OR FAMILY PHYSICIAN

_____________________________________________________________

           Name                                                       Phone

I give my consent for my family doctor to treat my child in case of emergency or if you are unable to contact him/her,

please accept this form as your authority to use the doctor on call in the emergency room for any necessary

emergency medical treatment.

_____________________________________________________________

Parent/Guardian's Signature                                   Date