Registration
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Joining a friend for class? Register here to complete your online waiver for Bring a Buddy week!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Father
Grandparent
Guardian
Mother
Other
Parent
Stepfather
Stepmother
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info (After Parents)
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if none):
Medications (Leave blank if none):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if none):
Medications (Leave blank if none):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if none):
Medications (Leave blank if none):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if none):
Medications (Leave blank if none):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if none):
Medications (Leave blank if none):
Questions/Options:
What is the name of the Gymsport student who invited your child to class?
*
Are there any physical, emotional, or behavioral concerns we should be aware of when instructing your child?
Additional Information:
Certification
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I certify that I am 18 years of age or older and that I have read, fully understand, and agree to the terms of this agreement, and I sign it voluntarily with full knowledge of its significance.
In consideration of the services of Gymsport, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I hereby agree to release, indemnify, and discharge Gymsport, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:
I've read the above and agree.
Acknowledgement of Risks
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I acknowledge that my participation in athletic training and instruction activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
The risks include, among other things: slips and falls; falling from equipment; rope burns; pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards; muscular tears, strains, sprains, dislocations, fractures and broken bones; cuts, bruises, and muscle soreness; wrist, arm and shoulder injuries; musculoskeletal injuries including head, neck, and back; injuries to internal organs; the negligence of other people; my own physical condition; and the risk of emotional and psychological injuries or physical damage associated with this activity. In any event, if me or my child is injured, any medical assistance will be at your own expense.
Furthermore, Gymsport employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction.
I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
I've read the above and agree.
Release
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I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Gymsport from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Gymsport 's equipment or facilities, including any such claims which allege negligent acts or omissions of Gymsport.
Should Gymsport or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
In the event that I file a lawsuit against Gymsport I agree to do so solely in the state of Pennsylvania, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Gymsport on the basis of any claim from which I have released them herein. I also agree that this document is valid for subsequent visits and participation at Gymsport.
I've read the above and agree.
Adequate Insurance
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I certify that I and my child(ren) have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.
I've read the above and agree.
Authority to Sign
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By signing below, I represent and warrant that I am the parent, legal guardian, or power-of-attorney of the above listed Child(ren) and have the authority to execute this Agreement on his/her or their behalf and to act on his/her or their behalf. I have read each and every paragraph in this document and I and they agree to be bound by the terms stated therein, including the release of liability contained therein. I further agree to indemnify and hold harmless Gymsport from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
I've read the above and agree.
Photo Release
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Gymsport periodically takes photos and videos of classes for training, promotions, and social media outlets. Student's personal information (i.e. last name, age, etc.) will never be used. If you do not wish to have your child's image used by Gymsport, you must inform us in writing by emailing lauren@gymsport.com.
I've read the above and agree.
Behavior
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I understand that any child exhibiting behavior that may cause harm to themselves, other students, or Gymsport staff may be removed from class. These behaviors include, but are not limited to, hitting, kicking, biting, or other forms of harassment.
I've read the above and agree.
Additional Notes
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Please be sure to check with your buddy for your specific class day and time.
Participants should wear athletic clothing with no buckles, zippers, or buttons. Halloween costumes are welcome, as long as it allows unrestricted movement and vision.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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