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Fee per Student:
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Room:
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Family Information |
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Students entered below will be added to your family's account
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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Additional Information: |
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Release of Liability
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I hereby waive any rights and those of my heirs, agents, assigns, or guardians for any claims or damages suffered by myself/my child's participation in any program. I hereby am choosing to continue my training at Granite State Gymnastics/Tumble Bees Learning Center. I hereby enter into this waiver for myself, my heirs, executors, assigns, and personal representatives. I do so knowingly and voluntarily. I hereby waive any and all rights, claims, or causes of action arising from any contraction or infection of the COVID-19 or any other infectious disease as a result of my continued training at Granite State Gymnastics/Tumble Bees Learning Center, along with its owners, members, agents, and representatives. I understand there are risk and I assume all known dangers and risk associated with my continued training at Granite State Gymnastics/Tumble Bees Learning Center. I fully confirm that I have not tested positive for COVID-19 nor do I have any symptoms currently related to COVID-19.
I've read the above and agree.
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Assumption of Risk
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I realize that myself/my child is a willing participant at Granite State Gymnastics/Tumble Bees Learning Center. I understand that all precautions will be taken to prevent accidents and will not hold the gym authorities responsible for any injury resulting from my/my child's damages suffered by myself/my child's participation in any program. I have communicated up to date information about any broken bone, heart trouble, asthma, allergies, or other health condition myself/my child has that Granite State Gymnastics/Tumble Bees Preschool & Fitness should know about.
I've read the above and agree.
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Medical Emergencies
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I give permission for Granite State Gymnastics/Tumble Bees Learning Center to transport myself/my child to a hospital and to receive medical treatment when I cannot be reached or when delay would be dangerous. I give permission for myself/my child to receive anesthesia if necessary for medical treatment during an emergency described above.
I've read the above and agree.
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Media Release
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For myself and/or my child, and/or any other minor or person for whom I am responsible: I hereby authorize Granite State Gymnastics and its photographers and agents to record my/his/her picture and/or voice via photographs, movies, films, tapes, or other media, incident to the activities without compensation or permission. I further authorize said parties to edit any recordings of such likeness and/or voice at its discretion, and to incorporate these recordings into print publications, internet and social media display, electronic publications, software, movie and sound films or tapes, broadcasts (radio, television and interest), programs, or otherwise, and to use and license others to use such publications, recordings, software, movie and sound films and tapes and broadcast programs in any manner of media whatsoever, including use for purposes of publicity, advertising and sale promotion. I understand that Granite State Gymnastics exclusively owns all rights to these recordings irrespective of the form in which they are produced or used.
I've read the above and agree.
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Other Questions/Comments: |
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Nickname:
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Card Expiration Month: * |
Exp Year: *
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Address Line 1:
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Address Line 2:
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City:
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State:
Zip:*
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