Registration
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By submitting this form you agree to the following; I affirm that all of the below information is correct to the best of my knowledge. I am aware that gymnastics urban gym and all other activities at Black Diamond are vigorous activities that may involve height and rotation in a unique environment and as such poses a risk of injury. I also understand that mats and other safety equipment and apparatus provided for my protection or that of my child, including the participation of a teacher who will assist in the performance of certain skills, may be inadequate to prevent serious injury. I hereby waive any and all claims resulting from ordinary negligence, both preset and future, that may be made by me or by my family. Once KNO is booked it is not refundable.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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Family Information
First Name:
*
Last Name:
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Type
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Child ( For Parties, Kids Night Out, Open workout
Doctor/Physician
Father
Grandparent
Guardian
Mother
Nanny
Other
Parent
Step Father
Step Mother
Home Phone:
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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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Zip:
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Emergency Contact Info
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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
Birth Date:
*
(format=mm/dd/yyyy)
School:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Questions/Options:
Does your child have any allergies? Please describe
Does your child have any special needs? Please describe
Is there anything you would like the coaches to know about your child?
Additional Information:
Non-refundable
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I understand once I enroll in a Kids Night Out event it is non-refundable.
I've read the above and agree.
What to Bring
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Please feed your child dinner before dropping off and send your child with a water bottle and snack for the night. Thank you!
I've read the above and agree.
Enter your Full Name:
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Other Questions/Comments:
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Exp Year:
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Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
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