Registration
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Born between 2014-2019
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
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Type
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Doctor/Physician
Emergency Contact
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State/Prov:
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Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code:
*
Emergency Contact Info
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:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medications/Other:
*
Party Disc-info from invite:
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medications/Other:
*
Party Disc-info from invite:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medications/Other:
*
Party Disc-info from invite:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medications/Other:
*
Party Disc-info from invite:
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medications/Other:
*
Party Disc-info from invite:
Questions/Options:
Previous cheerleading experience? Level: Division: Position(s): Cheer Gym: Number of Years:
*
Previous gymnastics or dance experience? Description: Gym or Dance studio: Number of Years:
*
Injuries/Medical Conditions that we should know about:
*
How did you hear about us? (ie. social media, within the gym, google, word of mouth, etc.)
*
Additional Information:
Assumption of Risk
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RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT. By signing this document you will waive certain legal rights, including the right to sue. PLEASE READ CAREFULLY. I acknowledge that severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, those activities include but are not limited to gymnastics, tumbling, trampoline, and cheerleading. I am also aware that participation in day camps involves transportation to and from field trips and such transportation could cause injury or death in vehicular accidents. Being fully aware of these dangers, I hereby give consent for my child(ren) to participate in any and all London Gymnastics Academy activities and I ACCEPT ALL RISKS associated with this participation. I also understand that London Gymnastics Academy/ London Heat Cheerleading has done all it can to create a safe and controlled environment for participants, and that all rules for participation must be adhered to. Failure to do so may result in the participant being asked to leave and the possible suspension or termination of membership. I HAVE READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS.
I've read the above and agree.
Release of Liability
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RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT. In consideration of London Gymnastics Academy accepting my application to participate in this activity, I agree to waive any and all claims that I may have in the future against London Gymnastics Academy and others. I agree to release London Gymnastics Academy/ London Heat Cheerleading and other from any and all liability for any personal injury, death, property damage, expense and related loss, including loss of income that I or my next of kin may suffer as a result of my participation in this activity, due to any case whatsoever, including negligence, breach of contract or breach of any statutory duty of care. I agree to hold harmless and indemnify London Gymnastics Academy Inc. and others from any and all liability for any damage to property of, or personal injury to, any third party, resulting from my participation in this activity. I agree that this agreement is binding on not only myself but my next of kin, heirs, executors, administrators and assigns. I HAVE READ THIS AGREEMENT AND UNDERSTAND IT. I AM AWARE THAT BY SIGNING THIS DOCUMENT I AM WAIVING CERTAIN RIGHTS WHICH I OR MY NEXT OF KIN, HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST LONDON GYMNASTICS ACADEMY INC. AND OTHERS.
I've read the above and agree.
Enter your Full Name:
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