Registration
Enjoy a much deserved time out, and let us entertain your child(ren) with pizza, bounce house, fun games, Open Gym Time, SWIM time, trampoline fun, and MORE during our monthly PNO! FOUR fun-filled hours; one great price! Time: 4:30-8:30pm Who: Kids ages 3-13 (preschoolers must be potty-trained) Cost: $25 per EGA Member $30 per Non-member $60 MAX per family! (Will be charged to card provided upon 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
(Not Contact #1 or #2)*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Would you like your child/ren to swim? If no, they will stay for crafts and more open gym.*
 
Additional Information:
 
Event Cancellation Policies
1. Registration Cancellation by Participant/Customer
• Unless specifically stated on registration materials, the deadline to receive an EGA account credit for your cancelled registration is two weeks before the scheduled event.
• Refunds/Credits are not available for registrants who do not attend the scheduled event.
• Cancellations are only accepted in written format: fax, email, signed note/letter.
2. Event Cancellation by Elite Gymnastics Academy, LLC (EGA)
• EGA reserves the right to cancel an event due to low enrollment or other circumstances that would make the event non-viable.
• If EGA cancels an event, registrants will be offered an EGA account credit.
• Should circumstances arise (e.g. hazardous weather conditions) that result in the postponement of an event, registrants will be allowed to transfer their registrations to the same event at the new, future date.
3. Birthday Party & Day Camp deposits are non-refundable and non-transferrable.

I've read the above and agree.
 
Payment Due to Register
I understand and approve EGA to charge the card I provide for the appropriate amount to register my child(ren) for the event upon registration.
I've read the above and agree.
 
EGA Liability Release and Indemnification
In consideration of Elite Gymnastics Academy, LLC allowing the gymnast to participate in sports activity, class, competition, team, including non-gymnastics
activities such as Ninja Zone, special events, birthday parties, field trips, open gym, open houses, camps, and playground activities (hereinafter referred to as
the "Activity"), I, and if I am not yet 18-years-old, my parents or legal guardians, agree to be bound as follows (the term “I” in this release refers to both the
gymnast/participant and his or her parents or legal guardians):
(1) Acknowledgement and Assumption of Risks. I understand the Activity involves risks of serious body injury, including permanent disability,
paralysis, and death, which may be caused by the gymnast’s actions or inactions, those of others participating in the Activity, the conditions in
which the Activity takes place, the negligence of the “Released Parties” named below, or other causes. I further understand there may be other risks
either not known to me or not readily foreseeable at this time. I fully accept and assume all such risks and all responsibility for losses, cost, and
damages that may result from the Activity and to transportation to and from the Activity.
(2) Representation of Ability to Participate. I understand the nature of the Activity, and I represent that the gymnast is qualified, in good health, and
in proper physical condition to participate in the Activity. Should I ever believe any of the above representations have become untrue, or if I should
ever believe the Activity is not safe or is no longer safe for the gymnast, then it will be my responsibility to immediately discontinue the gymnast’s
participation in the Activity.
(3) Release. I hereby release, acquit, covenant not to sue, and forever discharge Elite Gymnastics Academy, LLC, its owners, officers, administrators,
employees, agents, volunteers, sponsors, advertisers, coaches and supervisors, and the owners or lessors of any facilities within which the Activity
is conducted, their respective agents and employees, and all other persons providing facilities or assisting on the conduct of the Activity and in the
transportation of participants to and from the Activity (collectively the “Released Parties”) of and from any and all actions, caused of action, claims,
demands, liability, losses, or damages of whatever name or nature, including but not limited to those arising from or in any way related to the
negligence of any of the Released Parties, that arise out of or are connected in any way to the gymnast’s participation in the Activity and the
transportation of the above named gymnast to and from the Activity (collectively the “Released Claims”).
(4) Indemnification. I will defend, indemnify, and hold harmless the Released Parties from (that is, to reimburse and be responsible for) any loss or
damage, including but not limited to cost and reasonable attorney’s fees (including the cost of any claim I might make or that might be made on my
behalf or the gymnast’s behalf that is released in this document), arising out of or connected in any way with any of the Released Claims.
(5) Media Consent and Release. Elite Gymnastics Academy, LLC occasionally gathers photos and/or video media content about its Activities and any
photo and/or video taken of my child(ren) may be used for Elite Gymnastics Academy, LLC publicity and promotional purposes. I hereby grant
permission to Elite Gymnastics Academy, LLC to use, edit, and reuse my child(ren)’s photograph or likeness in any publicity or promotional media
materials including use in print, on the Internet, and all other forms of media. I also hereby release Elite Gymnastics Academy, LLC and its agents
and employees from all claims, demands, and liabilities whatsoever in connection with the above.

I've read the above and agree.
 
ASA Swim Waiver
Informed Consent & Waiver/Release of Liability
I, the undersigned, as the parent/legal guardian of the child(ren) listed on this form agree and understand that swimming is a hazardous activity, and I
recognize there are risks inherent in the sport of swimming, including, but not limited to, paralyzing injuries and death.
In registering my minor child(ren) to particpate in Atlantis Swim Academy, LLC swim lessons, programs, and/or events, I am agreeing to idemnify and hold
harmless Atlantis Swim Academy its instructors, officers, directors, agents, and employees against any liability resulting from any injury that may occur to my
child(ren) while participating in Atlantis Swim Academy, LLC swim lessons, programs, or events. I also agree to idemnify Atlantis Swim Academy, LLC for any
damages incurred arising from any claims, demand, action, or cause of action by my child(ren). Atlantis Swim Academy, LLC assumes no responsibility for any
personal property placed in or about the facility.
As the parent/guardian, I authorize any respresentative of Atlantis Swim Academy, LLC to have my child(ren) treated in any medical emergency during their
participation in Atlantis Swim Academy, LLC swim lessons, programs, or events. Further, the participant and/or parent/guardian agrees to pay all costs
associated with medical care and emergency transportation for the participant.
Pool Hygiene
I understand and accept that all children under the age of 3 and those not toilet-trained must wear a fitted, REUSABLE swim diaper (available for purchase at
ASA) over a disposable swim diaper while in the pool. Plastic training pans/regular diapers are NOT allowed.
Photos and/or Video
I also understand that photos and/or video are occasionally taken at Atlantis Swim Academy, LLC, and any photo and/or video taken of my child(ren) may be
used for Atlantis Swim Academy, LLC publicity and promotional purposes. I hereby grant permission to Atlantis Swim Academy, LLC to use, edit, and reuse my
child(ren)’s photograph or likeness in any publicity or promotional media materials including use in print, on the Internet, and all other forms of media. I also
hereby release Atlantis Swim Academy, LLC and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

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:*