Registration

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This one day clinic is perfect for the active child who aspires to be a ninja! Participants will learn rolls, jumps, kicks, and some beginner flips in combination with strength and agility courses.

Event:

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End Date/Time:

Fee per Student:

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Family Information

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

	Address: *
	City: *	State: * 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: *	Birth Date: * (format=mm/dd/yyyy)
	School:	Grade Level:
	List any known allergies/allergic reactions::
	List any Medications::
	Primary Doctor's Name & Phone # & Date of Last Exam:*
	List any previous surgeries:
	List any previous broken bones:
	List any other health concerns:

Questions/Options:


Student Name & Age
Current Student?
In order to plan and break the students into groups, can the student do a back handspring on the floor without assistance?

Additional Information:

Minor Consent and Assumption of Risk

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I understand the activities of gymnastics, tumbling, ninja training, dance etc. involve certain inherent risks, notwithstanding the safety precautions which are taken. I understand that these inherent risks include but are not limited to bodily injury, partial and/or total disability, paralysis and death. I understand the social and economic losses and/or damages, which could result from those risks and dangers, could be severe. I understand there may be other risks not known to us, or are not reasonably foreseeable at the time. Understanding these risks, I voluntarily agree to assume such risks on behalf of my child(ren). In consideration of your accepting my child(ren) as a student in your program, for myself, my heirs, my executors, administrators and assign, I waive, hold harmless and release any and all rights and claims for damages I have against Peoria Jump Start Kids Activity Center, Inc. dba Jump Start Gymnastics & Kids Activity Center, its sponsors, its agents, its employees, its representatives, successors and assigns, (hereafter collectively termed Jump Start Gymnastics & Kids Activity Center) for any and all injuries and losses suffered by my child(ren) and/or me and agree to indemnify and hold harmless Jump Start Gymnastics & Kids Activity Center for any claims by me or my child(ren) arising out of participation in any program or otherwise at Jump Start Gymnastics & Kids Activity Center or at any other location during an event sponsored by Jump Start Gymnastics & Kids Activity Center. Additionally; I hereby grant Jump Start Gymnastics & Kids Activity Center permission to render first aid emergency treatment which it considers necessary to my child(ren) or me while in attendance at Jump Start Gymnastics & Kids Activity Center, or at any other location during an event sponsored by Jump Start Gymnastics & Kids Activity Center and release all rights and claims for damages which said child(ren) or I may have against Jump Start Gymnastics & Kids Activity Center in connection with the rendering of said first aid emergency treatment.

Furthermore, I acknowledge the contagious nature of certain bacteria and viruses, including, without limitation, COVID-19, and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by such bacteria or viruses by attending Jump Start Gymnastics & Kids Activity Center and that such exposure or infection may result in personal injury, illness, permanent disability or death. I further understand that I am voluntarily allowing my child(ren) to participate in programs and activities offered by Jump Start Gymnastics & Kids Activity Center, knowing that it is impossible that my child(ren), myself or anyone else who enters the facility on my behalf is completely safe from exposure to any bacteria or virus, including the COVID-19 virus. I understand that the risk of becoming exposed to or infected by a virus or bacteria, including COVID-19, at the Jump Start Gymnastics & Kids Activity Center may result from the actions, omissions, or negligence of myself and others, including but not limited to Jump Start Gymnastics & Kids Activity Center employees, volunteers, and programs participants and their families.

I've read the above and agree.

COVID-19

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Jump Start Gymnastics & Kids Activity Center recognizes that while the state of Illinois has made substantial progress in the fight against COVID-19 and has allowed businesses to fully reopen, the majority of our participants remain ineligible to be vaccinated and others have not yet chosen to be vaccinated. In an effort to continue to make our facility as safe as possible for our students, families and staff, we have modified some of our policies and procedures. We ask that everyone strictly follow these revised policies to promote a healthy environment here at Jump Start. We thank you in advance for your cooperation.

First and foremost, IF ANYONE IN YOUR HOUSEHOLD OR SOMEONE YOU HAVE BEEN IN CONTACT WITH IS SICK OR EXHIBITING SIGNS OF AN ILLNESS, DO NOT COME TO JUMP START!
Fully vaccinated individuals are no longer required to wear a face covering anywhere in our facility.
Unvaccinated individuals must continue to wear a face covering throughout the facility, except when participating in activities and classes.
Unvaccinated individuals are encouraged to maintain six feet social distance from other individuals.
Although fully vaccinated people are not required to wear a face covering under state guidance, Jump Start supports students, customers and employees who choose to wear a face covering.
Everyone must enter the facility through the front door and are encouraged to exit the side door.
Everyone is encouraged to use hand sanitizer upon entering and exiting the facility. For your convenience, hand sanitizing and washing stations are available throughout the facility.
Students need to check in at the Check in desk before going to classes or activities. All individuals accompanying students into the facility must sign in at the check in desk.
Onsite spectator viewing will remain limited. Virtual viewing on the SPOT TV app will continue to be available for all registered students. Parents can watch classes from home, the car, or anywhere they would like with our new virtual viewing system. Access can be granted to out of town relatives, like grandparents, who can also watch their favorite child participate in their favorite weekly activities
How to get started:
Step 1 - Download the FREE mobile app. Offered on the Android App, Google Play or iPhone App, App Store.
Search the App Store for Spot TV Family.
Step 2 - On the App's home screen, select the button New here? Sign Up to complete your registration.
Step 3 - We will activate your account once your information and your child's viewing schedule has been verified!
When using stations in classes, stations will be socially distanced following RIYSP guidelines. In order to adhere to social distance guidelines, hands-on spotting will be limited to times when it is required to prevent injuries and keep participants safe.
No water fountains are available on site. Participants may bring water bottles that contain water only. Except for competitive team participants, water bottles will remain with personal belongings during class times.
PICK UP PROCEDURE: Parents may come into the facility to pick up students by entering the front door and exiting the side door. Parents may also park in one of the designated "Reserved Pick Up Only" numbered spots and text child's name and parking spot number to the Jump Start Pick up phone number. Participants will be escorted to the car. Parking is limited to 15 minutes in any one of the Reserved Pick Up spots.

Other Procedures in Place to Keep Everyone Safe and Healthy

All high touch areas in the facility will be routinely cleaned and disinfected throughout the day, especially during peak hours of operation.
High touch equipment used during classes and activities will be cleaned and disinfected after each group of participants.
All mats and equipment used for classes and activities will be thoroughly cleaned and disinfected minimally once a day.
All areas of the facility will be cleaned and disinfect

I've read the above and agree.

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