Registration
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*IF YOU ARE ALREADY AN EBG MEMBER, YOU CAN LOG IN USING YOUR EMAIL, NO NEED TO CREATE A NEW ACCOUNT* *** Phantom Pumpkin Fest: A Hauntingly Good Time*** Pumpkin Patch 9-4pm Haunted House 6-9pm *EARLY BIRD PRICING: * $5 - Haunted House $8 - Pumpkin patch, free small pumpkin, 1 hour jumpy house $12 - Pumpkin patch, free medium sized pumpkin, unlimited jumpy house $ 16 - Everything (pumpkin patch, free big pumpkin, jumpy house & haunted house) *DAY OF EVENT PRICING* $3 - 1 hour jumpy house $8 - haunted house $12 - pumpkin patch, free small pumpkin, 1 hour jumpy house $15 - pumpkin patch, free medium pumpkin, unlimited jumpy house $20 - pumpkin patch, free big pumpkin, jumpy house & haunted house (*Online Registration for all East Bay Gymnastics Special Events are set to the "Regular Pricing" rate. Customer Service will automatically adjust fees accordingly after registration after all questions/options answered*)
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
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Last Name:
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Type
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Aunt/Uncle
Doctor/Physician
Family Friend/Other
Father
Grandparent
Guardian
Mother
Nanny
Parent
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
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NJ
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OR
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Zip:
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Emergency Contact Info
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
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Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
Pumpkin Patch?
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Yes
No
Jumpy House? (If yes, please make sure to check either 1 hour or unlimited Jumpy House, otherwise, you will be charged unlimited Jumpy House)
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Yes
No
1 hour of Jumpy House?
(checked=yes)
Unlimited Jumpy House?
(checked=yes)
Haunted House?
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Yes
No
Additional Information:
Multiple Students
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Failure to complete the question above will result in a single student's registration. If you wish to register multiple students, the box above must be filled out in full. If students are not preregistered and show up on the day of the event, they will not be allowed to participate if space is not available. If space is available, you will be required to pay the drop-in price for each additional student. By checking this box, you agree that you have read and understand these terms.
I've read the above and agree.
Release of Liability
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As legal guardian(s) of the previously-declared participant(s), I(we) recognize that potentially severe injuries can occur in sports or activities involving height or motion, including gymnastics, tumbling, and trampoline. Being fully aware of these dangers, I voluntarily consent to the aforementioned person(s) participating in any and all programs at East Bay Gymnastics LLC., and I ACCEPT ALL RISKS associated with participation.
In consideration for allowing the previously declared participant(s) to use these facilities, I, on my own behalf and the behalf of my child and our respective heirs, administrators, executors, and successors, hereby covenant not to sue and forever release EBG LLC., its owners, officers, representatives, employees, or agents from all liability for any and all damages or injuries suffered by my child while under the instruction, supervision, or control of EBG LLC., including, without limitation, those damage or injuries resulting from acts of negligence on the part of its owner, officers, representatives, employees, or agents.
Parents, please make your children aware of the possibility of injury and encourage your children to follow all the safety rules and the instructor's instruction.
Parents or Guardians participating in a parent participation class agree to the follow: I, despite all reasonable precautions implemented for safety, am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses associated with participation in the programs or activities. I knowingly and willingly assume all such risks. Consequently, I hereby for myself, heirs, executors and administrators, do waive and release any and all rights and claims for damages against the owner, operators, coaches, and other members of EBG LLC. from personal injury or accident of any sort or nature suffered by me, the undersigned by reason of participation or membership in classes, lessons, or any programs or activities of EBG LLC.
I've read the above and agree.
Assumption of Risk
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Participation in physical activities can involve motion, rotation, and height in a unique environment and as such carries with it a certain assumption of risk. The undersigned and the participant(s) choose to voluntarily enter upon said premises under the control of said corporation, knowing their present condition and knowing that said condition may become more hazardous and dangerous during the time the participant or the undersigned is upon said premises. The undersigned and the participant(s) voluntarily assume any and all risks of loss, damage, or injury that may be sustained by the participant(s) and/or the undersigned or any property owner by them while on or upon said premises described above. The corporation may but shall not be obliged to carry insurance on the participant(s), and the existence of insurance shall not change, alter, or increase the liability of the corporation to the participant and the undersigned or affect the terms of this Release. In signing this Release, the undersigned acknowledges: a) That he/she has read thoroughly and understands completely, the terms of Registration and Release and signs it voluntarily.
b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal guardian and has the consent of the participant.
I've read the above and agree.
Medical Emergency
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The undersigned gives permission for the participant(s) to participate in programs at East Bay Gymnastics LLC. I fully understand that East Bay Gymnastics LLC. staff members are not physicians or medical practitioners of any kind. With that in mind, the undersigned hereby releases the East Bay Gymnastics LLC. owner, officers, employees, and/or agents to render temporary first aid to the participant(s) in the event of any injury or illness, or seek medical help, including transportation by a East Bay Gymnastics LLC. owners, officers, employees, agents and/or its representatives, whether paid or volunteer, to any healthy care facility or hospital, or the calling of an ambulance for said child should it be deemed necessary. Additionally, the undersigned hereby agrees that they themselves will provide for all medical expenses and all possible future medical expenses, which may be incurred by the participant(s) as a result of any injury sustained while participating at or for East Bay Gymnastics LLC.
I've read the above and agree.
Marketing Release
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I understand that my child's photograph may be used in East Bay Gymnastics LLC. ads, promotional videos, website material, or various other marketing. These images will be used for East Bay Gymnastics LLC. purposes only, and will not be given or sold to outside companies or individuals.
I've read the above and agree.
Payment Information
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PAYMENT: Payment is due at the time of registration for the event. Payment is required to reserve your child's place in the event. Your credit card will be charged once the business office completes your registration.
RETURNED CHECK: There is a $20.00 returned check charge for any checks returned by the bank. I understand that if I have checks returned for non-sufficient funds, or am late with payments, that East Bay Gymnastics LLC. will require automatic credit or debit card payments from that point forward.
I've read the above and agree.
Refund Policy
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No refunds will be granted.
I've read the above and agree.
Enter your Full Name:
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Other Questions/Comments:
Credit Card Verification:
Card Number:
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Visa
Mastercard
Name as it appears on card:
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Nickname:
Card Expiration Month:
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Exp Year:
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Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
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PR
VI
Zip:
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