Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact(s) Name / Phone
Students entered below will be added to your family's account
Previous Cheerleading Experience - List years and gym name
Current Tumbling Skills without a spot (list here)
Current Tumbling skills WITH a spot (list here)
Additional Information:
Registration Agreement

I understand that all fees paid to FUSION GYMNASTICS CENTER LLC are nonrefundable.

In addition, I agree to the following RELEASE AND WAIVER AGREEMENT

My athlete wishes to participate in the cheerleading practices, instruction, strength and condition training and other activities (the "Activity") as offered by Fusion Gymnastics Center, LLC (East Coast Evolution/FGC). Because of the risks associated with cheerleading, athletic training and the Activity, I have read and agree to the following Release and Waiver Agreement ("Agreement"):

1. Assumption of Risk. I understand that participating in the Activity entails risks of injury, including, without limitation, physical injury, disfigurement, paralysis, blood loss, muscle function or other injuries, including death ("Injury"). I am aware of the risk of Injury and am knowingly and voluntarily accepting the risk that such Injury may occur as a result of me participating in the Activity or otherwise being on the premises.

2. Warranty of Physical Fitness. I represent and warrant that I am physically fit and in a condition that will allow me to participate fully in the Activity. I am covered by medical insurance that covers me for Injury that may occur while participating in the Activity. Fusion Gymnastics Center, LLC will not make any investigation into my physical fitness or ability to participate in the Activity, and is fully relying on my representations of my physical condition and insurance set forth herein.

3. Release/Waiver of Claims. On behalf of myself and my heirs representatives and/or assigns, I hereby fully and completely release Fusion Gymnastics Center, LLC, its members, directors, officers, coaches, and employees, and the landlord/owner of the facilities at which the Activity occurs, from any and all claims, actions, causes of action, suits, and/or damages (including, without limitation, claims or loss caused by the negligent act or omission of Fusion Gymnastics Center, LLC or the landlord/owner, any instructions offered/withheld or the condition of the premises or equipment) related to any Activity. If any portion of this Release and Waiver is held invalid for any reason, the remainder shall not be affected and shall continue in full legal force and effect.

4. Emergency Medical Treatment. I grant Fusion Gymnastics Center, LLC permission to authorize emergency medical treatment as it deems appropriate and agree that such action shall be subject to the terms of this Agreement. I am solely responsible for all costs related to such medical treatment, medical transportation and/or evacuation.

All payments are nonrefundable. By agreeing to this text, I have read and understand the FUSION GYMNASTICS CENTER, LLC 2019-20 Athlete Handbook and agree to the policies and procedures as outlined.

I have read and understand the release, waiver and handbook in its entirety.

I've read the above and agree.
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