Start Date/Time: End Date/Time:
Fee per Family: Room:
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Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact Info*
Additional Information:
Release of Liability
In consideration of participating in the Granite State Gymnastics & Tumble Bee programs I represent that I and the participant(s) understands the nature of this activity and that the participant(s) is qualified, in good health, and in proper physical condition to participate in such activity. I acknowledge that if I and/or participant(s) believe event conditions are unsafe, he/she will immediately discontinue participation in the activity. I and participant(s) fully understand that this activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the "releases" named below; and that there may be other risks either not known to me and or participant(s) or not readily foreseeable at this time; and I and participant(s) fully accept and assume all such risks and responsibilities for loses, cost, and damages I and or participant(s) incur as a result of my participating the activity.
I and participant(s) hereby release, discharge, and covenant not to sue Granite State Gymnastics & Tumble Bees, its respective administrators, directors, agents, officers, volunteers, and employees, other participant(s)s, any sponsors, advertisers, owners and lessors of premises on which the activity takes place, (each considered one the "RELEASES" herein) from all liability claims, demands, losses or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the "Releasees" or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability and assumption of risk I, participant(s) , or anyone on my behalf, makes a claim against any of the Releasees, I and participant(s) will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage or cost, which any may incur as the result of such claim.

I've read the above and agree.
Assumption of Risk
I and participant(s) have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I and participant(s) have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extend allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.
And I, as the minor's parent and/or legal guardian, understand the nature of the above referenced activities and the Minor's experience and capabilities and believe the minor to be qualified to participate in such activity.

I've read the above and agree.
Medical Emergencies
I give permission for Granite State Gymnastics to transport my child to a hospital and to receive medical treatment when I cannot be reached or when delay would be dangerous.
I give permission for my child to receive anesthesia if necessary for medical treatment during an emergency described above.

I've read the above and agree.
I give Granite State Gymnastics the right to use my child(s) photograph or image with or without my child's name, both singly and in conjunction with other persons or objects and presentations, advertising, publicity, and promotion relating thereto.
I've read the above and agree.
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