Registration
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Nothing beats a Bay Aerials Gymnastics Kids Night Out Nerf Blaster Challenge. Obstacles, Fort building, Target Practice. Nerf guns, Safety glasses and ammo included. We'll keep their bodies fueled with a break for dinner (we provide pizza), spark their imaginations and creativity with a craft, and keep their minds and bodies active with plenty of time in the gym to bounce on trampolines, jump and flip into foam pits, swing on bars, balance on beams, and improve their gymnastics skills to their hearts content.Ages 5 and up.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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Family Information
First Name:
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Last Name:
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Type
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Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
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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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Emergency Contact Info
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
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(format=mm/dd/yyyy)
Student Email:
Allergies:
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Medications (Leave blank if NONE):
Primary Doctor:
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Add New Student #2:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
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(format=mm/dd/yyyy)
Student Email:
Allergies:
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Medications (Leave blank if NONE):
Primary Doctor:
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Add New Student #3:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Allergies:
*
Medications (Leave blank if NONE):
Primary Doctor:
*
Add New Student #4:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Allergies:
*
Medications (Leave blank if NONE):
Primary Doctor:
*
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Allergies:
*
Medications (Leave blank if NONE):
Primary Doctor:
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Questions/Options:
Number of Children
Total Fee ($75 1st Child, $65 each additional sibling) =
Late Fee = $5 per child If registering on the day of the event.
Is your child ok to have cheese or pepperoni pizza? Please specify.
On occasion we have ice cream as well. Is you child allowed to have ice cream?
Yes
No
Please let us know if your child has any allergies or special needs.
Are you a current customer?
(checked=yes)
Additional Information:
Waiver of Liabilty
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-- In consideration for my or my child(ren)s participation I hereby, for myself and my child(ren) and our respective heirs and successors, PROMISE NOT TO SUE and FOREVER RELEASE Bay Aerials Gymnastics, their respective officers, directors, shareholders, employees, contractors and volunteers from all liability resulting from damages or injuries incurred as a
result of participation including those resulting from acts of negligence.
I've read the above and agree.
Assumption of Risk
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--I hereby consent to his/her participation in gymnastics, tumbling and trampoline, swim, dance, karate, birthday parties, special events & activities including inflatables, camps and any and all other programs offered by Bay Aerials Gymnastics I understand that participation in gymnastics, trampoline, dance, and any and all other activities at Bay Aerials Gymnastics' may result in unavoidable injuries including, but not limited to, muscle or other soft tissue strains, sprains and tears, broken bones, and severe injuries such as paralysis, permanent disabilities, or even death from various causes, known and unknown, which include, but are not limited to, the heights of the equipment and the body during certain movements, rotation of the body, and movement of the body, in a unique environment. I am fully aware of the inherent risks involved in gymnastics, trampoline, dance, birthday parties, special events & activities including camps, and any and all other activities offered by Bay Aerials Gymnastics and the possibility of injury from participating in the aforementioned activities.
I've read the above and agree.
Release of Liability
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--In consideration for allowing my child to participate in activities offered by Bay Aerials Gymnastics, I, my heirs and assigns, next of kin, and all others acting on my behalf agree to waive any and all rights, claims, damages, actions, causes of action or suits of any kind or nature whatsoever which I have or my child has against Bay Aerials Gymnastics, or any agent, employee, representative or other acting on their behalf and to indemnify, defend and hold harmless Bay Aerials Gymnastics, or any agent, employee, representative or other acting on their behalf for any injuries suffered as a result of engaging in those activities offered by Bay Aerials Gymnastics, It is also my intent to release Bay Aerials Gymnastics, and any agent, employee, representative or other acting on their behalf from liability for ordinary or gross negligent conduct that may occur in the future and agree not to sue.
Should any part or parts of this agreement be held null and void, the gross balance of the gross agreement shall remain valid and maintain its full force and effect. This acknowledgment of risk and WAIVER OF LIABILITY has been read by me and understood completely and signed voluntarily. I am 18 years of age or older.
By agreeing to this I understand that even though I am not taking gymnastics, cheer, dance, lessons and will not be on the equipment I may injure myself being in the gym. I take full responsibility for my actions and agree to pay for any and all medical bills that might arise from an accident at Bay Aerials Gymnastics, This could include, but not limited to stepping off uneven mats and twisting an ankle, broken bones, torn ligaments, spine injuries or even death. This includes outside the building in the parking lot and all surrounding areas.
I've read the above and agree.
Medical Authorization
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-- In the event of an accident or emergency I hereby authorize my child(ren) to be transported to a hospital for medical treatment and I hold Bay Aerials Gymnastics and their representatives harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by myself or my child(ren) as a result of any injury sustained while participating at or for Bay Aerials Gymnastics.
-- In the event of an accident or emergency I hereby authorize my child(ren) to be transported to a hospital for medical treatment and I hold Bay Aerials Gymnastics and their representatives harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by myself or my child(ren) as a result of any injury sustained while participating at or for Bay Aerials Gymnastics.
I've read the above and agree.
Parent/Guardian Signature
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-- I have read and understand the above ASSUMPTION OF RISK and WAIVER OF LIABILITY and MEDICAL AUTHORIZATION and PHOTO RELEASE. In addition, I confirm that I am the parent/legal guardian of this registrant(s).
I've read the above and agree.
Payment
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--The total amount due will be charged to the Credit Card / Debit Account below
I've read the above and agree.
Cancellation
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-- No refunds or credits except with a WRITTEN medical authorization for cancellation on the day of the event.
I've read the above and agree.
Enter your Full Name:
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Other Questions/Comments:
Credit Card Verification:
Card Number:
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Visa
Mastercard
Name as it appears on card:
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Nickname:
Card Expiration Month:
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Exp Year:
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Address Line 1:
Address Line 2:
City:
State:
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AZ
CA
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DE
FL
GA
HI
IA
ID
IL
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KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
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Zip:
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