Registration

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Come join in the FUN FUN FUN! 8:00am-5:00pm Games, daily themes, tumbling, arts and crafts, contests, and so much more! A healthy snack will provided by The Matrix every morning and all participants MUST bring their own lunch! Get signed up now to reserve your spot! It's going to be the most fun you have ever had staying in Huntsville for Fall Break!

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: *
	Emergency Contact Name and Number*

Students entered below will be added to your family's account

Questions/Options:


Does your child have any food allergies that we need to be aware of?
I understand that I must have a signed online waiver on file at The Matrix for my child to participate in any Matrix activities, including Fall Break Camp. http://thematrixgym.com/matrix-waiver.html	(checked=yes)

Additional Information:

General Liability Waiver/Release

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RELEASE OF LIABILITY WAIVER:
In consideration for participation in activities at The Matrix Gym, I hereby agree to the following:
I, (we) despite all reasonable precautions implemented for safety, am (are) fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, etc. as well as other damages and losses associated with participation in the program or activities. I (we) knowingly and willingly assume all such risks. Consequently, I (we) hereby for myself, heirs, executors, administrators, do waive and release any and all legal rights and claims for damages against the owner, operators, coaches and other members of The Matrix staff (“releases”) from personal injury or accident of any sort or nature suffered by me (us), the undersigned, by reason of participation or membership in classes, lessons, birthday parties or any other programs or activities at The Matrix. I approve the use of any photographs taken by the Matrix in which the undersigned is part of to be used on the Matrix website or print media.

YOU ARE THE OPERATOR: I, for myself and my child(ren) or ward, have read the safety rules, agree to operate/abide on any piece of equipment at this facility on the behalf of any attraction participants and enforce all safety rules of The Matrix and/or the manufacturer of the equipment, and agree that the failure of myself, my child or my ward to follow these rules may result in injury or death.

I, the minor’s parent and/or legal guardian, understand the nature of these activities and the minor’s experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activities. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the release’s from all liability claims, demands, losses or damages on the minor’s account caused or alleged to be caused, in whole or in part by the negligence of the “releases” or otherwise, including negligent rescue operations. I further agree that is, despite this release, I, the minor, or anyone on the moor’s behalf make a claim against any of the releases named above, I will indemnify, save, and hold harmless each of the releases from any litigation expenses, attorney’s fees, loss liability, damage, or cost any may incur as the result of any such claim.

MEDICAL RELEASE: The undersigned gives permission to The Matrix, its employees, owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health. I understand that the medical personnel will decide which facility and doctor my child will be cared by and that The Matrix will not make those decisions on behalf of my child. In the event of an accident or emergency I hereby authorize my child(ren) to be transported to a hospital for medical treatment and I hold The Matrix and their representatives harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by myself or my child(ren) as a result of any injury sustained while participating at or for The Matrix.

PHOTO RELEASE: By you and your child(ren)’s participation in Matrix activities, you are granting your permission for you and your child to be filmed, videotaped, audio tape, or photographed, by any means and are granting full use of your likeness, voice and words without compensation.

I've read the above and agree.

Medical Emergency

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I've read the above and agree.

Photo Release

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I've read the above and agree.

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