Registration

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School is out! Join the staff at Jump Start Plus North for a day of gym time, games, and a craft! Please be sure to pack an allergy friendly lunch and a water bottle. Advanced Registration Required Time: 9am - 1pm Ages: 3-12 *Must be potty trained Cost: $45/Day

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
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	Primary Doctor's Name & Phone # & Date of Last Exam:*
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MINOR CONSENT & ASSUMPTION OF RISK WAIVER (Student under 18)

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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.