Registration

Registration

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Please use this event registration if you are not currently enrolled in a class at Gymnastics World.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

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)
	Student Email:
	School:	Grade Level:
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):
	Primary Doctor:
	Student Age:*
	Previous Cheer/Gym Experience?:

Questions/Options:


Is your child currently enrolled in a gymnastics class/team elsewhere? If yes, what class/level?*

Additional Information:

WAIVER OF LIABILITY

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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've read the above and agree.

MEDICAL AUTHORIZATION

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I've read the above and agree.

PHOTO RELEASE

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I've read the above and agree.

Enter your Full Name:

*

Other Questions/Comments:

Credit Card Verification:

Card Number: *

Name as it appears on card: *

Nickname:

Card Expiration Month: *

Exp Year: *

Address Line 1:

Address Line 2:

City:

State: Zip:*