Start Date/Time: End Date/Time:
Fee per Family: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact Info*
Additional Information:
I/We understand that participation in any instructional and/or recreational activities at Emerald City Gymnastics, Inc. (hereinafter referred to as ECG), including but not limited to: gymnastics, dance, ballet, cheerleading, trampolining, tumbling, Bump City, Monster Mountain (rock climbing), Ropes Course and any other related programs at ECG (the Programs) is voluntary, and that all Programs and the use of the related facilities and equipment therein carries some physical risk.
I've read the above and agree.
I/We understand that if I/we or my/our minor child is injured or our property is damaged while participating in the Programs, that the injury or loss will not be covered or reimbursable by ECG.
I've read the above and agree.
I/We agree to assume the risk of any and all illness or injury (minor, serious or catastrophic in nature, including claims and suits at law or in equity for any injury, fatal or otherwise) or damage (to person or property) resulting from participation in all Programs, whether allegedly resulting from my negligence or the alleged negligence of ECG or any of their employees or representatives.
I've read the above and agree.
I/We hereby waive all claims, on behalf of myself/ourselves and claims by my/our minor child (including claims which may be brought after attaining majority), now or in the future, for any such Damages and do hereby release and discharge ECG and its respective officers, directors, instructors, agents, employees and assigns from any and all liability for any such Damages.

I've read the above and agree.
I/We fully understand that ECG instructors, agents and employees (ECG Staff) are not physicians or medical practitioners of any kind. With the above in mind, I/we hereby release and grant permission to the ECG Staff to render temporary first aid to my/our child in the event of any injury or illness, and if deemed necessary by the ECG Staff to call a doctor to seek medical help, including transportation by an ECG Staff member, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the ECG Staff deem this to be necessary.
I've read the above and agree.
I/We assume full responsibility for all liability in connection with such Damages, and agree to indemnify ECG against any and all such claims and related costs, including claims by my/our minor child that may be brought after attaining majority.
I've read the above and agree.
I/We certify: (i) that my/our child is in good health and that he/she has no physical limitations which would preclude him/her from the safe use of the facilities and equipment related to the Programs offered by ECG; and, (ii) that I/we have sufficient health, accident and liability insurance to cover any Damages that may result as a result of my/our child participating in the Programs, and if I/we have no such insurance, I/we certify that I/we am/are capable of personally paying for any and all such Damages.
I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments: