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Schools Out Camp- Member Fee $55--Non-Member Fee: $65 ($10 multi child discount) The member fee will be posted to account, Dynamix will adjusted fee if needed before the card on file is charged.
Event:
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Family Information
First Name:
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Last Name:
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Email:
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(Emails are kept confidential)
Address:
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Zip:
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Emergency Contact Info (Not Contact #1 or #2)
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:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
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
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Birth Date:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #3:
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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:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #4:
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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)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #5:
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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:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
Add pizza lunch $8 per day (includes drink and snack).
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Yes
No
Additional Information:
ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND IND
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I have elected to allow my minor child under the age of 18 ("Participant") to participate in the gymnastics classes and events offered by Dynamix Gymnastics ("Dynamix") at 181 Wheeler Ct, Suite C, Langhorne, PA 19047 ("Premises"). As a condition to the Participant's participation in the foregoing activity (the "Program"), and for other good and valuable consideration described herein, I hereby acknowledge and agree to the following:
1. I understand and acknowledge that the Program involves intense physical activity, which can be dangerous and may expose the Participant to a variety of risks, dangers and hazards including, but not limited to, bodily injury, strains, partial and/or total paralysis, other ailments that could cause serious disability, or death. I understand that the injuries at risk include broken bones, muscle tears and sprains, and other orthopedic injuries, as well as cardiovascular problems, or other serious injuries that could cause temporary or permanent disability or death. I understand that these risks and dangers may be caused by the negligence of Dynamix, the negligence of the Premises at which the Program is located, the negligence of the Participant or other participants, the negligence of others, as well as accidents or other dangers that are integral to recreational or athletic activities.
2. I represent that the Participant is qualified, in good health, and in proper physical condition to participate in the Program. If I believe the Program is unsafe for the Participant, I will immediately stop Participant's participation. I hereby knowingly and voluntarily assume any and all such risks, including presently unknown or unforeseeable risks, and voluntarily assume all responsibility for losses, costs, and damages resulting from Participant's participation in the Program. I understand that Dynamix makes no representations or warranties of any kind about the skills or qualifications of the other participants in the Program or of the owners and/or operators of the Dynamix or the Premises at which the Program may be offered.
3. By my signature below, I hereby forever release and discharge Dynamix, its respective owners, officers, directors, employees, administrators, agents, staff members, successors and assigns ("Releasees"), on behalf of myself and my family, personal representatives, assigns, heirs, and next of kin, to the fullest extent permitted by law, from any and all liability, claims, demands, losses, responsibilities, costs or damages, however caused, whether related to property damage and/or personal injury or death, and whether based on tort, intentional act, strict liability, negligence, and/or negligent rescue, and whether or not it is the result of the negligence of the Releasees or otherwise, which the Participant or I may suffer while participating in the Program at the Premises or as a spectator in the Program. I authorize each of the Releasees to take whatever action is necessary, in their best judgment, in an emergency and I hereby release and discharge the Releasees from any responsibility or liability related thereto. I will indemnify, defend and hold harmless each of the Releasees from any claim, expense, attorney's fees, loss, liability, damage, attendance thereat to the fullest extent permitted by law.
4. I acknowledge that I have read the rules and regulations governing the use of the Premises. I agree that the Participant and I will fully comply with all rules and regulations and with any amendments.
5. I further understand that in order to promote the safety of Dynamix's employees and visitors, as well as the security of the Premises, Dynamix will conduct video surveillance of any portion of the Premises at any time, the only exception being private areas of restrooms and that video cameras will be positioned in appropriate places within and around the Premises and used in order to help promote the safety and security of people and proper
I've read the above and agree.
POLICIES
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--- Dynamix Gymnastics reserves the right to cancel or change program schedules due to low enrollment
--- Participant who cancels 1 week prior to the start of a fee-based Program may submit a credit request with a $10 processing fee
--- Cancellations after the start of the event will not receive a refund or credit
--- Refunds will not be given after the start of the event at any time for programs canceled by participants, unless a physician’s note is submitted with a refund request
I've read the above and agree.
WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19
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ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT
In consideration of being allowed to participate on behalf of the Dynamix Gymnastics program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death 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 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. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Dynamix 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; and,
5. I understand that coaches may/will need be in physical contact when spotting skills, training and other general coaching duties.
6. I understand Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a mean to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Dynamix Gymnastics programs or accessing Dynamix Gymnastics facilities could increase the risk of contracting COVID-19. Dynamix Gymnastics in no way warrants that COVID-19 infection will not occur through participation in Dynamix Gymnastics programs or the facility.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18)
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. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child's/ward's presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I ACKNOWLEDGE THAT I HAVE RECEIVED THE GUIDELINES AND AGREE TO ABIDE BY THEM. I UNDERSTAND THAT THE GUIDELINES MAY CHANGE AT ANY TIME BASED ON INDUSTRY, FEDERAL, STATE OR LOCAL MANDATES OR RECOMMENDATIONS.
I've read the above and agree.
Enter your Full Name:
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Name as it appears on card:
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