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Youth Ages 2-16 Join us for a Spooktacular Good Time We love Halloween and we love sharing our love of Halloween with our community. Please join us as we roll out the lights, ghosts and graveyards and prepare for a wicked haunted adventure!

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: *

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: *
	Birth Date: *	(format=mm/dd/yyyy)
	Allergies/Medical conditions that we should be aware of (Leave blank if NONE):

Add New Student #2:

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	Student's First Name: *	Last Name: *
	Birth Date: *	(format=mm/dd/yyyy)

	Allergies/Medical conditions that we should be aware of (Leave blank if NONE):

Add New Student #3:

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	Student's First Name: *	Last Name: *
	Birth Date: *	(format=mm/dd/yyyy)

	Allergies/Medical conditions that we should be aware of (Leave blank if NONE):

Add New Student #4:

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	Student's First Name: *	Last Name: *
	Birth Date: *	(format=mm/dd/yyyy)

	Allergies/Medical conditions that we should be aware of (Leave blank if NONE):

Add New Student #5:

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	Student's First Name: *	Last Name: *
	Birth Date: *	(format=mm/dd/yyyy)

	Allergies/Medical conditions that we should be aware of (Leave blank if NONE):

Additional Information:

Release of Liability

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I, the duly authorized parent or guardian of the below-named Minor “Participant”, understand that the individual and/or group gymnastics and other physical exercise sessions, programs or activities conducted at Action Kids at Brentwood Commons, Inc. (hereafter “Action Kids”) may involve gymnastics, tumbling, fitness, trampoline, cheerleading, dance, ball sports, swimming and martial arts, as well as the use of exercise equipment, amenities and facilities owned and/or operated by Action Kids, its representatives or its contractors (collectively, the “Activities”).

I, as the parent/guardian of the below-named Minor Participant, as a condition of authorizing their participation in such Activities do hereby agree to RELEASE and DEFEND, HOLD HARMLESS, and INDEMNIFY Action Kids, its shareholders, directors, officers, agents, faculty, volunteers, employees, representatives and contractors (hereinafter “the Releasees”) from all liability, claims, expenses, fees, fines, penalties, losses, suits, proceedings, actions and costs including attorneys’ fees and court costs, including personal injury and death, resulting from or arising out of their participation in the Activities whether caused by the alleged NEGLIGENCE of the Releasees or otherwise.

I understand that the Activities in which my child or ward will be engaged may be dangerous, and I, as their parent or guardian, voluntarily choose to assume those dangers. I also recognize that by participating in the Activities my child or ward may experience injuries including, but not limited to, death or disability, and I willfully ASSUME THOSE RISKS. I agree that THIS LIABILITY RELEASE AGREEMENT IS BINDING ON THE PARTICIPANT AND THEIR PARENTS OR LEGAL GUARDIANS, PERSONAL REPRESENTATIVES, HEIRS, AND ASSIGNS.