Registration
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Please be sure you have completed the paper packet and we are in receipt of it prior to starting camp. Please send a lunch, we will provide snacks.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
Caregiver
Father
Guardian
Mother
Parent
Pick-Up
Self
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
(Emails are kept confidential)
Address:
*
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
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (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)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (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)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (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)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (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)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
How did you hear about this camp?
*
Can your child/ren charge snacks to the card on file?
*
Yes
No
Additional Information:
Assumption of Risk
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I voluntarily enter into this agreement with Gulf Breeze Gymnastics, LLC (dba The FunPlex), intending for myself, my children, my parents, my spouse, my heirs, assigns, personal representative and estate to be bound by this agreement. In consideration for the services provided by Gulf Breeze Gymnastics, LLC (dba The FunPlex), their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I hereby voluntarily agree to release and discharge Gulf Breeze Gymnastics, LLC (dba The FunPlex) on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate and assume all risks involved in the participation by the participants named above in activities provided by Gulf Breeze Gymnastics, LLC (dba The FunPlex).
I've read the above and agree.
Release of Liability
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1. Participants acknowledge that gymnastics entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or other injury to participants or damage to property, or injury to third parties. Participants understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
2. The risks include, among other things: collisions with gymnastics equipment, personnel and other participants; supervised and unsupervised falls on and around gymnastics equipment; falls from stunts and/or pyramids, improper landings when dismounting equipment; equipment malfunction or failure; any and all of which may result in minor strains and sprains, broken bones, catastrophic injury, paralysis and even death; as well as, other injuries, damages, and losses associated with participation in a gymnastics activity.
3. Gulf Breeze Gymnastics, LLC (dba The FunPlex) employees have a difficult job to perform. They will stress safety at all times, but they are not infallible. They might be unaware of a participant's fitness or abilities. In this regard it is the participant's responsibility to inform Gulf Breeze Gymnastics, LLC (dba The FunPlex) if the participant feels they are unable to safely attempt an activity or portion of any activity. Without this information Gulf Breeze Gymnastics, LLC (dba The FunPlex) employees may give inadequate warnings or instruction. We perform routine equipment maintenance, however equipment malfunction may still occur.
4. Participants expressly agree and promise to accept and assume all risks existing in this activity. Our involvement in this activity is purely voluntary, and we elect to participate in spite of the risks involved. Additionally, we acknowledge an understanding of and agree to follow all rules and regulation established by Gulf Breeze Gymnastics, LLC (dba The FunPlex)
5. Participants hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Gulf Breeze Gymnastics, LLC (dba The FunPlex) from any and all claims, demands, or causes of action, which are in any way connected with our participation in this activity or our use of Gulf Breeze Gymnastics, LLC (dba The FunPlex) equipment or facilities, including and such claims or actions which may allege negligent acts or omissions of Gulf Breeze Gymnastics, LLC (dba The FunPlex), their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf. We hereby give our consent to Gulf Breeze Gymnastics, LLC (dba The FunPlex) to provide customary athletic training attentions, transportation, and emergency medical services reasonably warranted in the course of our participation.
6. In the event I file a lawsuit against Gulf Breeze Gymnastics, LLC (dba The FunPlex), I agree to do so solely in the state of Florida, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state.
7. Should Gulf Breeze Gymnastics, LLC (dba The FunPlex) or anyone acting on their behalf be required to incur attorney's fees and costs to enforce this agreement, we agree to indemnify and hold Gulf Breeze Gymnastics, LLC (dba The FunPlex) harmless for all such fees and costs.
8. We certify that we have adequate insurance to cover any injury or damage we may cause or suffer while located on Gulf Breeze Gymnastics, LLC (dba The FunPlex) property, or else we agree to bear the costs of such injury or damage ourselves. We further certify that we have no medical or physical condition that could interfere with our safety in this activity, or else we are willing to assume all risks and bear all costs of any resulting injury or damage directly or indirectly related to any such condition.
9. By signing this document, we acknowledge that if anyone is hurt or property is damaged during our participation in this activi
I've read the above and agree.
Photo/Video Release
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I authorize the FunPlex of Gulf Breeze and Gulf Breeze Gymnastics and Cheer, LLC to take, record, use, broadcast, or publish photographs, videotape, or audiotape of the Participant/s in any media and for any lawful purpose whatsoever, including promotion or publicity of any event or activity directed by the aforementioned. I waive any rights the Participant/s or I may have to approve or disapprove the finished product and/or use of such materials and to receive any royalties, profits, or proceeds from such materials or finished product. I understand and will abide by the Staff, Coach, Athlete, and Parent Expectations.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
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Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
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01
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Exp Year:
*
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
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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