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Thank you for booking your Paint and Play Night at GymStars Stockton. This is a fun filled adventure for kids ages 5 and up. Come paint with us and take your art home! It is a fun way to spend time with your family and take home a cherished one-of-a-kind artwork! All supplies are included in the price. If you have any questions please call us at (209) 957-1919.

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Family and Information

	First Name:*	Last Name: *
	Relationship to Student*
	Home Phone:*	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Who do we contact in case of an emergency (Name, Phone #, & relationship to student)?*

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	School:	Grade Level:
	Any Disabilities we should be aware of?:*
	Does the student have any medication intolerances or allergies (whether environmental or medical)?:*
	Does the student require any special medications?:*
	Who is the Students primary Doctor & Phone number?:*
	May we use child's image?:*
	Trial Class Only ? (Yes or No):*

Add New Student #2:

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What is your Credit Card Billing Address?*
Was this Paint and Play reservation completed while inside the GymStars Facility?*
Is there a participating child that is a GymStars Stockton Member?*
If you answred yes to # 3 Please, list the member(s) name(s). If no, then type N/A*
List the Names and Ages of ALL attendees. *

Additional Information:

Release and Waiver or Liablity and Indemnity

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GYMSTARS GYMNASTICS, INC. RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

FOR AND IN CONSIDERATION of being permitted to utilize the facilities, services and programs of GymStars Gymnastics, Inc. (or for my children to participate) for any purpose, including, but not limited to observation, use of the facilities or equipment, or receiving instruction, training, or supervision, participation in any onsite or off-site program with, on behalf of, or affiliated with GymStars Gymnastics, Inc., or travel to and from any off-site program, THE UNDERSIGNED, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating, will inspect and carefully consider such premises and facilities and/or the program. It is further warranted that such entry into the GymStars Gymnastics premises for observation or use of any facilities or equipment or participation in any program constitutes an acknowledgment that such premises, all facilities and equipment thereon, and such programs have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, or participation by the undersigned and such children and assumes the risks arising from the conditions of the premises, equipment and/or program. I further acknowledge, understand, appreciate and agree that my participation, or my children's participation, may result in possible exposure to and illness from infectious diseases, including, but not limited to, MRSA, Influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation and exposure.

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER GYMSTARS GYMNASTICS FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO, OBSERVATION, USE OF FACILITIES OR EQUIPMENT, RECEIVING INSTRUCTION OR TRAINING, OR PARTICIPATING IN ANY ON-SITE OR OFF-SITE PROGRAM AFFILIATED WITH GYMSTARS GYMNASTICS, INC., THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

1. THE UNDERSIGNED, ON HIS OR HER BEHALF AND ON BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE GYMSTARS GYMNASTICS, INC., its directors, officers, employees, coaches, volunteers and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all their personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned or such children whether caused by the negligence of the releasees or otherwise while the undersigned or such children are in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with GymStars Gymnastics, Inc.

2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them, from any loss, liability, damage, or cost they may incur due to the presence of the undersigned or such children in, about or upon the premises of GymStars Gymnastics, Inc. or in any way observing, or using the facilities, or equipment thereon, or participating in any program affiliated with GymStars Gymnastics, Inc. whether caused by the negligence of releasees or otherwise.

3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to the negligence of releasees or otherwise while in, about or on the premises of GymStars Gymnastics, Inc. and/or while using the premises or any facilities or equipment.