Registration
SOMERSault Jungle Competitive Team Tryouts
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: *
Alternate Emergency Contact Info
(Not Contact #1 or #2)
 
 
Students entered below will be added to your family's account
 
Questions/Options:
How long have you been doing gymnastics?*
Have you ever been on a competitive gymnastics team? If yes, what level did you compete?
 
Additional Information:
 
Acknowledgment and Assumption of Risk
I understand that the Activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused, in whole or in part, by the gymnast's actions or inactions, those of others, the conditions in which the Activity takes place, the negligence of the "Released Parties" named below, or other causes. I further understand that 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. I hereby give my approval of and consent to the gymnast's participation in the Activity. I assume all risks and hazards incidental to the Activity and to transportation to and from the Activity.
I've read the above and agree.
 
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 and emotional condition to participate in the Activity. Should I ever believe that any of the above representations have become inaccurate and/or untrue, or if I should ever believe that 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.
I've read the above and agree.
 
Release and Indemnification
Release: I hereby release, acquit, covenant not to sue, and forever discharge SJG, 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 in 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, causes 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 actual 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"). 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 costs 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.
I've read the above and agree.
 
Medical Emergencies: Consent to Treat Minor Children
I, parent or legal guardian of enrolled child, (hereinafter "Participant"), hereby give consent to SOMERSault Jungle Gymnastics, LLC (hereinafter "SJG") to provide the Participant , through medical personnel of SJG's choice, reasonable and customary medical assistance, transportation and emergency medical service should the Participant require medical care as a result of his or her participation in any SJG event and/or program, including sports activity, class, competition, team and non-gymnastics activities such as swimming and playground activities (hereinafter collectively "Activity"). Reasonable efforts will be made to contact the parent or legal guardian of the Participant to notify them of the Participant's injury as a result of their involvement in an Activity and need for medical care; however, if the parent or legal guardian cannot be reached, SJG shall be allowed to exercise its rights pursuant to this Consent form and have the Participant treated.
I acknowledge and agree that I will at all times be responsible and pay for reasonable charges in connection with the care and treatment rendered to the Participant. Should SJG incur any expense associated with the care and treatment provided to the Participant, I agree to immediately indemnify reimburse SJG for its expenses.
I also authorize SJG to disclose a copy of this form or the information contained therein to any medical provider of its choosing should the Participant need medical care as a result of an Activity and the parent or legal guardian could not be reached. It is the Parent's/Guardian's responsibility to notify SJG of any changes and/or updates to this information.

I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments: