Registration
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You are invited to a field trip at Head Over Heels! We are very excited to have you join us! In order for your child(ren) to participate in this event, a parent or guardian must fill out the following information! If you do have questions that pertain to our facility and programs, please reach out to us at Contact@headoverheelsvestal.com. If you have questions regarding the details of this field trip, please contact your child's school or child care! We are looking forward to seeing you soon!
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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Home Phone:
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Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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ME
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Zip:
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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:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Additional Information:
Acknowledgement of Photo/Video Release
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By Selecting "Yes" on this policy, you are confirming that you UNDERSTAND the Head Over Heels Photo/Video Policy. On the Electronic Registration Form, there is a place to select either Yes or No to permit the collection and use of photos and videos. PHOTO/VIDEO POLICY - Head Over Heels Gymnastics of Vestal, LLC (HOHG) has a program whereby webcams are in use and my children are under streaming video surveillance that is used for training and management purposes, in addition to, secure accessibility from the web in accordance with the terms and conditions associated with the Spot TV website (also referred to herein as “Spot TV”). By Agreeing to this policy, I hereby consent to the photographing of myself and/or my minor child(ren) and the recording of my voice and or that of my child(ren). Head Over Heels may take either photos or videos of students which may be used on the Head Over Heels Gymnastics website, Facebook page, Instagram Account, in newsletters and publications as well as distributed to members. These photos or videos may be used by Head Over Heels Gymnastics to promote Head Over Heels Gymnastics in the future.
I've read the above and agree.
Medical Emergencies - Permission to Treat
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I fully understand that HOHG's staff, owners and representatives are not physicians or medical practitioners of any kind. With the above in mind, I hereby grant consent and permission to HOHG's staff, owners and representatives to render temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the HOHG staff to call our doctor and to seek medical help, including transportation by a HOHG staff member and/or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the HOHG staff deem this to be necessary.
I've read the above and agree.
Notice of Risk / Release and Waiver of Liability
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We, the staff of, owners and representative of FLGA Inc., d/b/a Head Over Heels Gymnastics, Head Over Heels Gymnastics of Vestal, LLC, D & J of Vestal, LLC (collectively, "HOHG") recognize our obligation to make our students and their parents aware of the risks and hazards associated with the sports of gymnastics, tumbling, ninja and cheerleading. Students may suffer injuries, possibly minor, serious, or catastrophic in nature. Gymnastics, tumbling, ninja and cheerleading can be dangerous and lead to injury! Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and the coach's instructions. HOHG, its coaches and other staff members will not accept responsibility for injuries sustained by any student during the course of gymnastics, tumbling, ninja or cheerleading instruction, or open workouts or in the course of any exhibition, competition, or clinic in which he or she may participate or while traveling to or from the event. By signing this form, I acknowledge these risks of injury, and I agree that HOHG, its staff, owners and representatives will not be responsible for any such injuries. With the above in mind, and being fully aware of the risks and possibility of injury involved, I consent to have my child or children participate in the programs offered by HOHG. I, my executors or other representatives, waive and release all rights and claims for injuries or damages that I or my child may have against HOHG and/or its staff, owners or representatives whether paid or volunteer. I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage, which I consider adequate for both my child's protection and my own protection. I have read and also understand HOHG's registration information and policies. I also understand that it is the parents' responsibility to warn the child about dangers of gymnastics, tumbling, ninja, cheerleading and injury. The parents should warn the child according to what the parent feels is appropriate. HOHG will only warn the child through "safety messages" and our teaching style and progressions. Any and all Gymnastics, Tumbling, Ninja and Cheerleading Skills will be conducted in a safe gym environment and will hold HOHG harmless of any injuries incurred in and outside gym areas.
I've read the above and agree.
COVID-19 Addendum
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This is an Addendum to the Waiver you have previously signed with us as a member. By signing this Addendum, you understand and agree to the following terms: You are aware that by entering this facility, you agree to fully accept all known and unknown risks, including the potential risk of exposure to respiratory illnesses such as the coronavirus (COVID-19). The coronavirus is primarily transmitted via exhaled respiratory droplets, most often through coughing and sneezing. These droplets can travel up to six feet in the air and are more commonly transmitted between persons rather than from equipment to persons. Although we regularly sanitize our equipment and presently are using enhanced cleaning methods and requiring social distancing in our facility, you understand that you may be exposed to the coronavirus or its symptoms through no fault of our own. Known coronavirus symptoms include fever, coughing, shortness of breath, pneumonia, kidney failure, and may include other symptoms, stroke or even death (collectively, "Symptoms"). You understand and agree that you will hold us harmless from and you will not hold us liable for you or any of your family members contracting COVID-19 or suffering any real or perceived Symptoms of COVID-19 or any other disease, illness, or condition, nor for exacerbating any existing symptoms, and you agree to accept fully all risks of entering the facility, using the equipment, working with coaches/instructors, attending classes, and/or interacting with or being exposed to our staff, other members or any other persons who are present in the facility. You also understand and agree that although we are requiring social distancing, if a coach/instructor or staff member, in their sole judgment, deems it necessary or appropriate, he/she may spot a student for their safety even if such spotting involves a breach of social distancing rules.
I've read the above and agree.
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