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 Info*
Students entered below will be added to your family's account
Additional Information:
Release of Liability
Risk and Waiver of Liability
My child has my permission to attend classes/activities at Amplitude Gymnastics Academy. In addition, my child and I are participating in gymnastic classes/activities under the terms and conditions set out below.
To the extent permissible by law, I/we hereby release, discharge and/or otherwise hold harmless and indemnify Amplitude Gymnastics Academy, it's owners, officers, directors, employees and associated personnel, from and against any and all demands, claims and causes of action arising, directly or indirectly, from my or my child's participation in its programs. THIS RELEASE SPECIFICALLY INCLUDES ANY DEMANDS, CLAIMS AND CAUSES OF ACTION ARISING OUT OF THE PAST OR FUTURE NEGLIGENT ACTS AND/OR OMISSIONS OF AMPLITUDE GYMNASTICS ACADEMY, IT'S OWNERS, OFFICERS, DIRECTORS, EMPLOYEES AND ASSOCIATED PERSONNEL.

I've read the above and agree.
Assumption of Risk
Assumption of Risk
I agree that I am aware that my child named above will be engaging physical exercise involving various sports, coordination events, and fitness training which could cause serious injury to him/her. I understand that there are certain risks of injury inherent with the practice and play of this sport, as well as other related activities incidental to his/her participation. I agree that my child is voluntarily participating in these activities and is assuming all risks, loss, damage, or injury.

I've read the above and agree.
Medical Emergencies
Medical Authorization
I give permission for Amplitude Gymnastics Academy owners, officers, employees, and/or agents to seek emergency medical treatment for the participant(s) in the event they are unable to reach any parent or guardian. The undersigned also agrees that they themselves will be responsible for any financial debt incurred by said action.

I've read the above and agree.
Photography/Video Release
Marketing Release
Occasionally Amplitude Gymnastics Academy uses photos or video of its students in print ads, on its website, or other marketing mediums. I understand that my child's likeness may be used in such advertising. These images will be used for Amplitude Gymnastics Academy purposes only and will not be given or sold to outside companies or individuals.

I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*