Registration
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Join us for our Winter Break Open Gym from 6:15 pm - 7:15 pm! This event is are open to all customers ages 6 to 12. Friends and family of current students may register for $15. Cash only at the door.
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
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Uncle
Home Phone:
Cell #:
Work #:
Email:
*
(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
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
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Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Age:
*
Previous Cheer/Gym Experience?:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Age:
*
Previous Cheer/Gym Experience?:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Age:
*
Previous Cheer/Gym Experience?:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Age:
*
Previous Cheer/Gym Experience?:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Age:
*
Previous Cheer/Gym Experience?:
Additional Information:
WAIVER OF LIABILITY
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-- I HEREBY RELEASE, DISCHARGE AND HOLD HARMLESS GYMNASTICS WORLD INC. FROM ANY AND ALL LIABILITY FOR LOSS OR INJURY, including death, or damages to persons or property sustained by me or my child(ren) while on or about the Gymnastics World Inc., facilities or in connection with any activity or program of Gymnastics World Inc. including but not limited to any injury or loss occurring as a result of the negligence of Gymnastics World Inc., its employees, agents, contractors, volunteers, officers, directors, shareholders, and affiliated entities, a claim for loss of consortium, wrongful death, negligent infliction of emotional distress or any other claim. I, as agent for and on behalf of my child(ren), my spouse/partner, or my child(ren)'s guardian or guardians, or anyone having temporary supervision or custody over my child(ren), including but not limited to, my or my child's relatives by affinity or blood, or persons employed to supervise my child such as a babysitter, release, discharge and hold harmless Gymnastics World Inc. from any liability for any claim any such person may have for loss of consortium, wrongful death, negligence, negligent infliction of emotional distress, damage to person or property or any other claim, that may arise out of any injury, mishap, or event on or about the Gymnastics World Inc. facilities or occurring in connection with any activity or program of Gymnastics World Inc., its affiliated entities, respective officers, directors, shareholders, employees, contractors, and volunteers.
I've read the above and agree.
AGENT AUTHORIZATION AND INDEMNIFICATION
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--I have authority to act on behalf of my spouse/partner or my child's guardian(s) or anyone having temporary supervision or custody over my child(ren), including but not limited to my or my child's relatives by affinity or blood, or persons employed to supervise my child such as a babysitter, and all such persons have read and understood this waiver, have agreed to its terms, and agree to release and discharge Gymnastics World Inc. from any liability for any claim for loss of consortium, wrongful death, negligence, negligent infliction of emotional distress, damage to property or any other claim, that may arise out of any injury, mishap, or event on or about the Gymnastics World Inc. facilities or occurring in connection with any activity or program of Gymnastics World Inc, its affiliated entities, respective officers, directors, shareholders, employees, contractors, and volunteers. I AGREE TO INDEMNIFY GYMNASTICS WORLD INC. AGAINST ANY CLAIM brought by my spouse/partner or my child(ren), my child(ren)'s guardian(s), and anyone having temporary supervision or custody over my child(ren), including but not limited to my or my child's relatives by affinity or blood, or persons employed to supervise my child such as a babysitter, for loss of consortium, wrongful death, negligence, negligent infliction of emotional distress, damage to property or any other claim, that may arise out of any injury, mishap, or event on or about the Gymnastics World Inc facilities or occurring in connection with any activity or program of Gymnastics World Inc., its affiliated entities, respective officers, directors, shareholders, employees, contractors, and volunteers. I shall not permit any person who has not read, understood and agreed to the terms of this waiver to supervise my child(ren) on or about, or transport my child(ren) to or from, the Gymnastics World Inc. facilities or any activity or program of Gymnastics World Inc., its affiliated entities, respective officers, directors, shareholders, employees, contractors, and volunteers.
I've read the above and agree.
CONSIDERATION
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-- I recognize that this agreement allows Gymnastics World Inc to offer affordable recreation and to continue to do so without the risks and overwhelming costs of litigation. This is part of the valuable consideration for which I, my child(ren) and/or my spouse/partner, or my child(ren)'s guardian or anyone having temporary supervision or custody over my child(ren), including but not limited to my or my child's relatives by affinity or blood, or persons employed to supervise my child such as a babysitter, gladly grant this waiver and indemnification, and agree to shoulder the risk of injury of loss.
I've read the above and agree.
MEDICAL AUTHORIZATION
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-- In the event of an accident or emergency I and/or my spouse/partner or my child(ren)'s guardian hereby authorize my child(ren) to be transported to a hospital for medical treatment and I and/or my spouse/partner or my child(ren)'s guardian hold Gymnastics World, Inc and their representatives harmless in the execution of such. Additionally, I and/or my spouse/partner or my child(ren)'s guardian hereby agree to individually provide for all medical expenses which may be incurred as a result of any injury sustained while participating at or for Gymnastics World Inc., occurring or caused on or about the Gymnastics World Inc. facilities, or occurring in connection with any activity or program of Gymnastics World Inc., its affiliated entities, respective officers, directors, shareholders, employees, contractors, and volunteers.
I've read the above and agree.
PHOTO RELEASE
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--I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for my or my child(ren)'s participation I hereby grant my permission and/or my spouse/partner or my child(ren) guardian's permission for my child(ren)'s likeness to be used in Gymnastics World, Inc., and affiliated entities, programs and activities, publicity or advertising.
I've read the above and agree.
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