Registration


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
 
Additional Information:
 
Please read this Liability Release Form
In consideration of allowing the previously- declared participant(s) to begin participation in Reflex Gymnastics activities, while on the premises and property of said Center, the undersigned,for themselves, and/or being the legal and acting guardian of participant, acting for themselves on behalf of the participant, release and hold harmless Reflex Gymnastics, it's owners, officers, employees, and agents of and from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises upon which Reflex Gymnastics is conducted, or any premises under the control and supervision of Reflex Gymnastics, its owners, officers, employees, or agents or in route to or from any of said premises, or while at any premises or place when activities sponsered by or participated in by Reflex Gymnastics, it's owners, officers, employees, or agents.


Participation in physical activities can involve motion, rotation, and height in a unique environment and as such carries with it a certain assumption of risk. The undersigned and the participant(s) choose to voluntarily enter upon said premises under the control of said corporation, knowing their present condition and knowing that said condition may become hazardous and dangerous during the time the participant or the undersigned is upon said premises. The undersigned and the participants(s) voluntarily assume any and all risks of loss, damage, or injury that may be sustained by the participant(s) and/or the undersigned or any property owner by them while on or upon said premises described above. The corporation may but not obliged to carry insurance on the participant(s), and the existence of insurance shall not change, alter, or increase the liability of the corporation to the participant and the undersigned or affect the terms of this Release. In signing this Release, the undersigned acknowledges:

a) That he/she has read thoroughly and understands completely, the terms of Registration and Release and signs it voluntarily.
b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal guardian and has the consent of the participant.

The undersigned gives permission for the Reflex Gymnastics owners, officers, employees, and/or agents to seek emergency medical treatment for the participant(s) in the event they are unable to reach any parent or guardian. The undersigned also agrees that they themselves will be responsible for any financial debt incurred by said action.

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:*