Registration
Already a customer? Click here to login.
Waiver to attend events at Mid Iowa Gymnastics
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Emergency Contact
Father
Guardian
Mother
Parent
Self
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 (Not Contact #1 or #2)
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (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)
Disabilities (Leave blank if NONE):
Allergies (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)
Disabilities (Leave blank if NONE):
Allergies (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)
Disabilities (Leave blank if NONE):
Allergies (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)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
What are the birth dates of the child or children attending Mid Iowa Gymnastics?
*
Additional Information:
Acknowledgement of Risk and Waiver of Liability
(Show-Hide Details)
I (we) recognize that despite all reasonable precautions implemented for safety, potentially severe injuries including permanent paralysis or death can occur in any activity involving height or motion, including, but not limited to gymnastics, tumbling, and trampoline. I (we) knowingly and willingly assume all such risks and therefore consent to enroll at Mid Iowa Gymnastics. Consequently, I (we) hereby for myself, heirs, executors and administrators, do waive and release any and all rights and claims for damages against members, operators, coaches and other members of Mid Iowa Gymnastics & More LLC, its successors and/or assigns from personal injury or accident of any sort or nature suffered by myself or my child by reason of participation or membership in classes, lessons or any programs or activities of Mid Iowa Gymnastics. In addition, I (we) hereby give permission to trained medical professionals to administer emergency medical treatment should sickness or accident occur in my absence. I understand that all medical expenses incurred due to injury resulting from participation are my responsibility.
I've read the above and agree.
Photo Release
(Show-Hide Details)
I (we) give permission for photographs, video and interviews of my child to be published in the newspaper, Mid Iowa Gymnastics website or other media and in any materials promoting Mid Iowa Gymnastics programs.
I've read the above and agree.
Presence of Adult
(Show-Hide Details)
For children age 1-3 years, they must be accompanied by an adult in the gym. If my child is between these ages, I hereby agree to have an adult present for the duration of Open Gym. However parents are not allowed on the equipment.
I've read the above and agree.
Health and Sickness
(Show-Hide Details)
I (we) understand and will not knowingly bring my child to Mid Iowa Gymnastics with a fever or any kind of sickness that is contagious or that has been around a person who has a contagious illness . In addition if your child has been sick please do not bring them into the gym for 3 days after they have fully recovered. I (we) also understand that Mid Iowa Gymnastics will do everything possible to reduce the risk of contagious illnesses in our gym. However there is still a risk of passage of illnesses in any public space and Mid Iowa Gymnastics can not be held responsible for those outcomes. I (we) understand that Mid Iowa Gymnastics coaches do need to assist and spot children during class and practice and we will minimize this interaction as much as possible.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Please Wait...
