Registration
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Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Relationship to student
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
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AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
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ME
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MT
NE
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Zip:
*
Emergency Contact Info (Not Contact #1 or #2)
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
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):
Add New Student #2:
(Show-Hide Details)
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):
Add New Student #3:
(Show-Hide Details)
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):
Add New Student #4:
(Show-Hide Details)
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):
Add New Student #5:
(Show-Hide Details)
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):
Additional Information:
Parental Consent
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I am the parent or legal guardian of each child I have enrolled in an event at OGI.
I've read the above and agree.
Assumption of Risk
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In consideration of participating in the above referenced program(s) at the Ohio Gymnastics Institute, Inc., I, the minor student's parent and/or legal guardian, represent that I understand the nature of this activity and that my minor child is qualified, in good health, and in proper physical condition to participate in such activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue my child's participation in the activity. I fully understand that this activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my child's own actions or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the releasees named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I and/ or my child incurs as a result of participation in the activities.
I've read the above and agree.
Release of Liability
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I hereby release, discharge and covenant not to sue the Ohio Gymnastics Institute, Inc., its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of the premises on which the activity takes place (each one considered as the releasees herein) from all liability, claims, demands, losses, or damages, on my and the minor's account caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise, including negligent rescue operations and further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my or the minor's behalf, makes a claim against any of the releasees, I will indemnify, save, and hold harmless each of the releasees from any loss, liability, damage, or cost, which any may incur as the result of such claim.
I've read the above and agree.
Medical Emergencies
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I understand that OGI Employees are not physicians or medical practitioners. I grant permission to Ohio Gymnastics Institute, Inc. staff members to provide emergency first aid and, in the event that efforts by OGI staff to contact me are unsuccessful, arrange for transportation to an emergency medical facility if necessary.
I've read the above and agree.
Picture Policy
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I understand that at times OGI and its affiliates may take photographs or other images of activities in the gym for media and public relations purposes. Accordingly I, as a parent of a minor student: (a) authorize OGI and its affiliates in perpetuity, without compensation or limitation, to reproduce, disseminate, and/or publish my and the student's image, name, voice, photograph, and/or likeness for media coverage, public relations, or any other lawful purpose, which may involve the use of photographs, names, films, and/or videotape recording and/or any other form of media, whether currently in existence or not; and (b) understand that OGI/its affiliates retain title and unlimited rights to all such media.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
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Name as it appears on card:
*
Nickname:
Card Expiration Month:
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Exp Year:
*
2024
2025
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2033
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2035
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2038
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2040
2041
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2044
2045
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2049
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2051
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2053
2054
Address Line 1:
Address Line 2:
City:
State:
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AR
AZ
CA
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CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
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MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
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OK
OR
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TN
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VT
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PR
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Zip:
*
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