Registration
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Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
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DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
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ME
MI
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MO
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NE
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NH
NJ
NM
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OH
OK
OR
PA
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SC
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VA
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WA
WI
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Zip:
*
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
Non Binary
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
*
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non Binary
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non Binary
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
*
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non Binary
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non Binary
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
*
Questions/Options:
Please specify the name and ages of children attending from your family.
*
Additional Information:
Permission and Notification of Risk
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The above named participant has my permission to attend and participate in the Advantage Gymnastics Academy LLC programs. I confirm that to the best of my knowledge my child is in good health and is fit to participate in gymnastics and related activities and is free from any medical condition that would limit his/her activity. I understand that there is inherent danger and a resulting possibility of injury or death, which may be incurred during my child's participation in gymnastics, cheerleading, trampoline, dance and related activities. Gymnastics, cheerleading and related activities, like any other athletic activity involving motion, rotation and height involves a risk of injury. I acknowledge that if I believe event conditions are unsafe or I am unable to safely perform any activity, I will immediately discontinue participation in the activity.
I've read the above and agree.
Waiver and Assumption
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In consideration of the acceptance of this registration to participate in Advantage Gymnastics Academy, LLC programs, I for myself, family members, heirs, executors, administrators, assigns, and any minor that accompanies me, agree to RELEASE, HOLD HARMLESS and INDEMNIFY Advantage Gymnastics Academy LLC and its owners, members, managers, directors, employees, contractors, subsidiaries or agents any and all right and claims for any loss, injury, or damage which arises or results from participation in any programs offered by Advantage Gymnastics Academy LLC. I attest and verify that I have knowledge of the risks involved in these programs and I will assume those risks for the participant registered above. As part of this Release and Waiver, I agree that I will not sue or make any claim against Advantage Gymnastics Academy LLC or any of its owners, members, managers, directors, employees, contractors, subsidiaries or agents for any losses or damages described herein. I HAVE CAREFULLY READ THIS RELEASE OF LIABILITY, FULLY UNDERSTAND ITS CONTENTS AND AGREE TO IT OF MY OWN FREE WILL.
I've read the above and agree.
Consent to Medical Care and Treatment of a Minor
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CONSENT TO MEDICAL CARE AND TREATMENT OF A MINOR. I hereby authorize Advantage Gymnastics Academy LLC or any employee or representative thereof to call any medical or other emergency personnel and/or arrange for medical treatment, including diagnostic, hospital or surgical procedures as may be prescribed or performed by a treating physician for the above name participant, if I cannot be reached in the case of any emergency. This consent includes, but not limited to, examinations, tests, medical treatment, administration of necessary anesthetics, transfusions, or drugs and the performing of whatever operation may be deemed necessary or advisable. It is understood this authorization is given in advance of any specific diagnosis, the undersigned with notice to the treating physician and hospital, or until the undersigned void their signature hereon. Attempts will be made to contact the parent/guardian prior to medical treatment.
I've read the above and agree.
Medical Expenses
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I accept full responsibility for all medical expenses incurred as a result of my child's participation in or travel to and from any programs offered by Advantage Gymnastics Academy LLC. I agree to HOLD HARMLESS and INDEMNIFY Advantage Gymnastics Academy LLC for any claims brought to me by my child.
I've read the above and agree.
Audio and Image Consent
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I hereby grant permission to Advantage Gymnastics Academy LLC and its members, managers, employees, agents, and assigns to photograph my child(ren) and further authorize and consent to the use of any such images by Advantage Gymnastics Academy LLC for all appropriate purposes including without limitation marketing and promotional materials, website use, posters, mailings, and any other use that Advantage Gymnastics Academy LLC, in its sole discretion, determines to be appropriate and reasonable. For the purposes of this Agreement, "photograph" and "image" will include still photography, videotape, electronic video capture, and any other method which may be used to capture a still or moving image. I understand and agree that Advantage Gymnastics Academy LLC may use of any images without compensation.
I've read the above and agree.
Enter your Full Name:
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