Registration
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Join us for a very special monthly family open gym event! After a half-hour of "Feelings Rock" with Ms. Taylor, you can enjoy an hour of open gym! The price is $20 per family with one child, and $5 per additional child. Space is limited! Please let us know how many kids you expect to bring, so that we can estimate attendance in advance. Payment (cash , or we can charge the credit card associated with your account) will be due the day of the event, in advance of participating.
Event:
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Fee per Family:
Room:
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First Name:
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Last Name:
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Type
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Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
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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Zip:
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Add New Student #1:
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Student's First Name:
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Last Name:
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Birth Date:
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(format=mm/dd/yyyy)
Physical Limitations or Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Other Medical Conditions (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
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Last Name:
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Birth Date:
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Physical Limitations or Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Other Medical Conditions (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
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Last Name:
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Birth Date:
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Physical Limitations or Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Other Medical Conditions (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
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Last Name:
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Birth Date:
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(format=mm/dd/yyyy)
Physical Limitations or Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Other Medical Conditions (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
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Last Name:
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Birth Date:
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(format=mm/dd/yyyy)
Physical Limitations or Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Other Medical Conditions (Leave blank if NONE):
Questions/Options:
How many children will you be bringing under age 5?
How many children will you be bringing age 5 and up?
Additional Information:
Assumption of Risk
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In consideration for being provided the ability to participate in this activity at Delaware Dynamix, I, and my minor child, signing below hereby stipulate and agree:
Acknowledgement of Danger. I understand and acknowledge that the Activity my Child wants to participate in is extremely strenuous. I recognize and understand these Services are not without varying degrees of risk, which may include, but are not limited to the following: (1) PHYSICAL INJURY AND/OR DEATH including minor injuries and major injuries such as joint and back injuries, broken bones, concussions, rhabdomyolysis, musculoskeletal injuries, cardiovascular injuries, heart attack, stroke, and brain injury; (2) exposure to, and sickness from, infections viruses, bacteria and disease, including but not limited to, COVID-19; and (3) property damage. I understand that the Premises may contain toys or other items that other children have brought along with them, and I willingly accept the risk related to these objects being around and/or in contact with my Child. I further acknowledge that any injury my Child may sustain while participating in the Activity may be compounded by improper use or failure of equipment, a known or unknown medical condition, negligent or delayed medical service, or negligent or delayed assistance by the Company.
Acceptance of Responsibility. I willingly assume full responsibility for any and all risks that I am exposing my Child to as a result of my Child’s participation in any Activity in the Premises and training program and accept full responsibility for any injury or death that may result from their participation.
Assumption of Risk. Understanding, acknowledging, and accepting all the risks and hazards involved with the Services, I freely and voluntarily choose to all my Child to participate, enter, and use the Premises, and I, FOR MYSELF AND ON BEHALF OF MY CHILD, HEREBY VOLUNTARILY AND EXPRESSLY AGREE TO ACCEPT AND ASSUME ALL RISK OF LOSS, DAMAGES, THEFT, INJURY OR DEATH THAT MAY OCCUR TO MY CHILD OR THEIR PROPERTY AS A RESULT OF OR INCIDENT TO MY CHILD’S PARTICIPATION IN THE SERVICES, INCLUDING THE RISK THEY MAY BE INJURED BY THE ACTIONS, OMISSIONS, REPRESENTATIONS OR NEGLIGENCE OF THE COMPANY, ITS OWNERS, AGENTS, OFFICERS, PRINCIPALS, EMPLOYEES, INDEPENDENT CONTRACTORS, VOLUNTEERS, OR ANY OTHER PERSON ASSOCIATED WITH COMPANY (“RELEASED PARTIES”), OTHER PARTICIPANTS OR THIRD PARTIES WHILE PARTICIPATING IN THE SERVICES OR FROM OR USING OR VISITING THE PREMISES. I understand and agree that this Agreement will be binding on me, my spouse (or registered domestic partner), my guardians, the executors or administrators of my estate, my heirs, my personal representatives, my assigns, my successors in interest, my children, and any guardian ad litem for said children (collectively, the “releasors”). I accept full and complete responsibilitafor the safety of myself, any guests, observers or other individuals who I have invited to the Premises, and property we have brought to the Premises, and I assume the risk of damage, theft, loss or injury caused by others to me, my guests and our property. I also accept full and complete responsibility for the consequences of my Child taking unreasonable risks while participating in the Services or using the Premises, including, without limitation, attempting activities that my Child not qualified to perform safely, causing any other participants/spectators an unreasonable risk of harm, or failing to follow correct safety procedures when using the Premises and participating in the Services provided by Delaware Dynamix.
I've read the above and agree.
Release from Liability
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Release from Liability and Waiver. In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily allowing my Child to participate in the Services, I HEREBY WAIVE RELEASE AND FOREVER DISCHARGE ON MY BEHALF AND MY CHILD’S BEHALF ANY AND ALL CLAIMS OR CAUSES OF ACTION, NOW KNOWN OR HEREAFTER KNOWN IN ANY JURISDICTION THROUGHOUT THE WORLD, AGAINST THE RELEASED PARTIES, INCLUDING, WITHOUT LIMITATION, ANY BODILY INJURY OR DISABILITY, ILLNESS OR DISEASE, ACCIDENT, DEATH, FINANCIAL LOSS, PROPERTY LOSS, DAMAGE, DESTRUCTION, DELAY, INCONVENIENCE OR OTHER HARM OF WHATEVER NATURE THAT MAY BE DIRECTLY OR INDIRECTLY RELATED TO, ARISING FROM OR SUSTAINED FROM PARTICIPATION IN THE SERVICES AND/OR USE OF THE PREMISES OR ACTIVITIES RELATED THERETO, NEGLIGENT FIRST AID OR EMERGENCY RESPONSE OF THE RELEASED PARTIES OR OTHER NEGLIGENT ACT OR OMISSION OR BREACH OF ANY EXPRESS OR IMPLIED WARRANTY OF ANY RELEASED PARTIES OR OTHERWISE, provided that nothing in this Section shall be deemed to release any Released Party from liability arising from their own willful or intentional injury to me or my property.
Indemnification. I SHALL INDEMNIFY, DEFEND, AND HOLD HARMLESS THE RELEASED PARTIES, JOINTLY AND SEVERALLY, FROM AND AGAINST ANY AND ALL CLAIMS, ACTIONS, DEMANDS, RIGHTS, LOSSES, COSTS, DAMAGES, EXPENSES, SETTLEMENTS, JUDGMENTS, CAUSES OF ACTION AND LIABILITIES OF ANY KIND WHATSOEVER, WHETHER FORESEEN OR UNFORESEEN, INCLUDING ATTORNEYS’ FEES, IN LAW OR IN EQUITY, ARISING OUT OF OR RESULTING FROM ANY CLAIM RELATED TO MY CHILD’S PARTICIPATION IN THE SERVICES, INCLUDING WITHOUT LIMITATION, MY OR MY CHILD’S BREACH OF THIS AGREEMENT OR PREMISES RULES AND POLICIES, ANY INDIVIDUAL WE INVITE TO THE PREMISES, OR ANY OTHER THIRD PARTY CLAIM RELATED TO THE SERVICES.
Covenant Not to Sue. I agree, for myself, my Child, and all my heirs, not to sue the Released Parties or initiate or assist in the prosecution of any claim for damages or cause of action against the Released Parties which I, my Child, or my heirs may have as a result of any personal injury, death or property damage my Child may sustain while on or using the Premises or while participating in the Activity.
Waiver of Terms. No waiver of any term or right in this Release and Waiver of Liability agreement shall be effective unless in writing, signed by an authorized representative of the waiving party. The failure of any party to enforce any provision of this agreement shall not be construed as a waiver or modification of such provision, or impairment of its right to enforce such provision or any other provision of this agreement thereafter.
Governing Law and Venue. This Release and Waiver of Liability agreement will be governed by and interpreted in accordance with the laws of the State of Delaware, without giving effect to the principles of conflicts of law of such state. I agree that any action arising out of this Release and Waiver of Liability agreement must be brought exclusively in any state or federal court located in Sussex County, Delaware.
Compliance with Laws. In the performance of the terms of this Release and Waiver of Liability agreement and use of the Premises, the parties shall comply with all applicable federal, state, regional and local laws, rules and regulations.
Parental Consent: I, the undersigned parent or legal guardian of the minor child, have read the above and understood the foregoing assumption of risk, and release of liability, and agree to its terms on behalf of my child and myself. I understand that by signing below, I am giving up substantial rights on behalf of my child and myself.
I've read the above and agree.
Enter your Full Name:
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Name as it appears on card:
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Zip:
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