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Evaluation Request for NEW student for intermediate or advanced level classes. Girls and Boys Ages 6 to 16 years with prior gymnastics experience. $25.00 will be charged when the evaluation date and time is scheduled. The $25.00 will be credited to your account once enrolled in a class! We offer evaluations for new & returning students who have previous experience and would like to see if they would be appropriate for our intermediate or advanced gymnastics levels. Please only schedule an evaluation if your gymnast has attended a structured gymnastics program within the past year. Evaluations are not a guarantee of placement within any specific level of our Rebounders Recreational Program. PLEASE IGNORE THE 12/31 DATE! Once we receive your request, our Recreational Program Coordinator will get in touch with you to schedule an evaluation appointment which will take approximately 40 minutes. PLEASE COMPLETE THE ENTIRE FORM!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
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Last Name:
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Type
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Aunt/Uncle
Brother
Father
Grandparent
Guardian
Mother
Nanny
Other
Owner/Director
Parent
Sister
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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DC
DE
FL
GA
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Zip:
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Nonbinary
Birth Date:
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(format=mm/dd/yyyy)
Name of School:
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Allergies and/or Medications (Leave blank if NONE):
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Date of Trial Class- $35.00 :
Desired Start Date for classes:
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Notes :
Add New Student #2:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Nonbinary
Birth Date:
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(format=mm/dd/yyyy)
Name of School:
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Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $35.00 :
Desired Start Date for classes:
*
Notes :
Add New Student #3:
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Student's First Name:
*
Last Name:
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Student Gender:
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Female
Male
Nonbinary
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
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Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $35.00 :
Desired Start Date for classes:
*
Notes :
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Nonbinary
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $35.00 :
Desired Start Date for classes:
*
Notes :
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Nonbinary
Birth Date:
*
(format=mm/dd/yyyy)
Name of School:
*
Allergies and/or Medications (Leave blank if NONE):
:
Date of Trial Class- $35.00 :
Desired Start Date for classes:
*
Notes :
Questions/Options:
Previous Gymnastics Experience/Skills on Floor:
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Previous Gymnastics Experience/Skills on Vault:
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Previous Gymnastics Experience/Skills on Uneven Bars (Girls) Parallel/High Bars (Boys):
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Previous Gymnastics Experience/Skills on Balance Beam: (If Boy, write N/A):
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Previous Gymnastics Experience/Skills on Pommel Horse: (If Girl, write N/A):
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Previous Gymnastics Experience/Skills on Rings: (If Girl, write N/A):
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Please list some Days and times that you are available to bring your child to an evaluation. We will be in touch to schedule the appointment.
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Additional Information:
Age and Experience
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I understand that my child must be at least 8 years of age and have prior gymnastics experience on all gymnastics equipment.
I've read the above and agree.
WAIVER AND RELEASE OF LIABILITY
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DISCLAIMER: REBOUNDERS GYMNASTICS IS NOT RESPONSIBLE FOR ANY INJURY OR LOSS OF PROPERTY TO ANY PERSON WHILE PRACTICING, TAKING CLASS, COMPETING, PARTICIPATING IN OPEN GYM, OR IN ANY OTHER WAY INVOLVED IN GYMNASTICS AT REBOUNDERS GYMNASTICS FOR ANY REASON WHATSOEVER, INCLUDING ORDINARY NEGLIGENCE ON THE PART OF REBOUNDERS GYMNASTICS, ITS OWNERS, OFFICERS, AGENTS, OR EMPLOYEES.
In consideration of my child’s participation, I hereby release and covenant not-to-sue Rebounders Gymnastics ,Inc. and any of their owners, officers, employees, teachers, coaches, or agents, from any and all present and future claims resulting from ordinary negligence on the part of Rebounders Gymnastics, Inc. or others listed for property damage, personal injury, or wrongful death, arising as a result of my child engaging in or receiving instruction in gymnastics, or any other activities or any activities incidental thereto, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future, that may be made by me, my family, estate, heirs, or assigns.
I agree to indemnify and hold harmless Rebounders Gymnastics and all others listed for any and all claims arising as a result of my child engaging in or receiving instruction in Rebounders Gymnastics, Inc. activities or any activities incidental thereto whenever, wherever, or however the same may occur.
I am aware that gymnastics is a vigorous activity involving height and rotation in a unique environment. This includes the active participation of a coach or teacher who will spot or assist in the performance of certain skills. The risk of harm may be limited by all of the safety equipment and trained coaches, but never eliminated. I am voluntarily allow my child to participate in this activity with the knowledge of the risks involved and hereby agree to accept any and all inherent risks of property damage, personal injury, or death.
I understand that this waiver is intended to be as broad and as inclusive as permitted by the law of the state of Maryland and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be within the state of Maryland.
I affirm that I am of legal age and am freely signing this agreement. I have read this form and fully understand that by signing this form, I am giving up legal rights and or remedies which may be available to me for the ordinary negligence of Rebounders Gymnastics, Inc. or any person listed above.
I've read the above and agree.
WAIVER/RELEASE FOR COMMUNICABLE DESEASES
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In consideration of being allowed into the building and/or to participate on behalf of Rebounders Gymnastics, Inc. gymnastics and exercise program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1. Being on the premises and participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19 and influenza. Rebounders employees follow USA Gymnastics Safe Sport guidelines; and, while particular rules and personal discipline may reduce this risk, the risk of serious illness does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child's and my own or family member presence and/or participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
4. This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases.
5. I, for myself and on behalf of my family, and participating child, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Rebounders Gymnastics their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
6. At this time, teachers will only be spotting children when necessary for safety.
I've read the above and agree.
Payment Authorization
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I hereby authorize Rebounders Gymnastics, Inc to charge my MC, Visa or Discover card provided for the $25.00 Evaluation fee at the time of registration. This fee is non refundable and will be credited towards your child's first month's tuition once registered for a class.
I've read the above and agree.
Enter your Full Name:
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Other Questions/Comments:
Credit Card Verification:
Card Number:
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Visa
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Name as it appears on card:
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Nickname:
Card Expiration Month:
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Address Line 1:
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City:
State:
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MD
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MT
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Zip:
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