Medical Release Form Medical Release Form Please fill out the following Medical Release Form. Child's Name* First Last PhoneEmergency Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother's Name First Last Mother's Cell PhoneFather's Name First Last Father's Cell PhoneEmergency Contact* Emergency Contact Phone*Acknowledgment of Risk & Waiver of LiabilityAs legal guardian of (child's name above), I hereby consent to the aforementioned person participating in ACF, Inc. activities. I recognize that potentially severe injury, including permanent paralysis or death can occur in any activity involving height or motion, including gymnastics and related activities such as tumbling and trampoline. I understand that it is the express intent o ACF, Inc. to provide for the safety and protection of my child and, in consideration for allowing my child to use the facilities, I hereby forever release ACF, Inc., its officers, employees, teachers and coaches, from all liability for any and all damages and injuries suffered by my child while under the instruction, supervision, or control of ACF, Inc. As legal guardian of aforementioned person, I hereby agree to individually provide for the possible future medical expenses which may be incurred by my child as a result of any injury sustained while training at, or performing for ACF, Inc. This acknowledgement of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its contents and intent.Waiver* I have read the Acknowledgment of Risk & Waiver of Liability. Signature of Legal Guardian* Enter your first and last name. By entering your name, you agree to the contents of this form and that all information submitted is correct.Today's Date* Permission for Medical TreatmentI authorize the necessary steps regarding medical attention (i.e. first aid, calling ambulance service or transporting to the hospital) and will allow authorized hospital staff to treat my child for any illness or injury she/he has.Permission* I have read the Permission for Medical Treatment List Known AllergiesPast Injuries/Special information we should know aboutSignature of Legal Guardian* Enter your first and last name. By entering your name, you agree to the contents of this form and that all information submitted is correct.Today's Date* This iframe contains the logic required to handle AJAX powered Gravity Forms.