Summer Camp Registration Form

For many years we have wanted to offer the youth in our community an option to keep children active when school lets out beyond our normal evening Instructional programs.

Our Kids Camp offers working parents an option for their school-age children to stay active in a safe, clean environment with certified staff who have years of experience with children in an after-school setting.

As parents ourselves, we understand the importance of physical activity and how the benefits of physical activity impact our youth in many ways including:
- Strengthening their Heart & Lungs
- Improving Energy Levels
- And Enhancing the Emotional Wellbeing of a child
Beyond the physical benefits our after school program offers school-age children, being involved in our program helps children by:
- Creating a sense of belonging
- Improving Social Skills
- Providing Academic support
- Providing a safe environment
- And Building confidence
Children need a healthy dose of activity and movement after school and we are HERE for YOU to help! It takes an entire community of caring individuals to help raise a child beyond the family unit and we are here to help while offering a safe, clean, fun, active environment for children.

Camp is designed for children ages 6+

See Camp rates below:
- Daily Drop in- $39 (must have a 48 hour notice prior to camp)
- Weekly Camp- $139
  - Siblings attending camp receive 25% off

Policies & Proceedures
Dress Code:
- Tennis shoes are recommended for daily activities. Sandals and flip-flops are discouraged but may be brought on outdoor water days.
- All clothing should be comfortable and weather-appropriate.
- Please remember to bring a jacket when the temperature is below 50 degrees so children may play outside.
- All parents are asked to provide one bottle of spray sunscreen (SPF 50+ and waterproof) on the first day of summer day camp.
Discipline:

Appropriate behavior and language are expected at Tumble Shine. Rules will be clearly stated by counselors. Our goal is to always use redirection and positive reinforcement. At times, time-outs and quiet time may be required for children who need some additional space and calming.

Release of Participants:

All children must be signed in and out by a parent or authorized pick-up contact each day. Only those who have been designated to pick up a child are allowed to pick up. If someone else is picking up your child, we will ask that you complete an “Add a Contact” form in advance.

Medications:

A child may not receive medication of any kind unless it is required by a doctor.Parents/guardians must place medicine in a Ziploc bag with child’s name, dosage and frequency. Medication must be provided in the original container with pharmacy/doctor instructions and a label.

Illness:

Please inform the director immediately if your child develops any of the following symptoms:
- Fever
- Cough
- Redness of the eyes or itchy eyes
- Sore throat or hoarse voice
Students with these symptoms will not be allowed to attend kids camp until they are 24 hours free of symptoms or have a doctor’s note. Additional hand-sanitizing measures and social distancing – as possible – will be monitored and enforced throughout the school year.

Outdoor Information:

Please send one bottle of spray sunscreen with your child on the first day for outdoor playtime. (SPF 50 or above)We will provide liquid sunscreen for faces. The bottles will be shared with everyone. If your child has sensitive skin or requires a higher SPF, please attach a note and label the bottle with your child’s name.

How many Children are you registering for camp?
Athlete Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
2. Athlete's Name

First Name Last Name
2. Birth Date

Month Day Year
3. Athlete's Name

First Name Last Name
3. Birth Date

Month Day Year
4. Athlete's Name

First Name Last Name
4. Birth Date

Month Day Year
5. Athlete's Name

First Name Last Name
5. Birth Date

Month Day Year
Gender

Male Female
Grade
Current School
Please choose the camp weeks your child will be attending below:
Please chose the weeks your child will be attending camp below (If you are unsure leave blank): *

Unsure May 27th (1 Day) May 30th- Jnue 3rd ( Messy Kids Camp) June 6th-June 10th ( Spy Kids Camp) June 13th - 17th ( Superhero Camp) June 20th - June 24th (Heart of a Champion Camp) June 27th - July 1st (Candy Landy Camp) July 5th - July 8th (All American Camp) July 11th- July 15th (You've got talent camp) July 18th - July 22nd (Mad Scientist Camp) July 25th - July 29th (Creative Adventures Camp) August 1st - August 5th (Ninja Camp) August 8th - August 12th (Animal Adventures Camp)
Parent/Guardian Information
Name *

First Name Last Name
Home Number *
E-mail *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Zip Code
Pick Up Authorization
Who may pick up your child besides parent/guardian(s) listed above?
Health Record
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgment

I hereby give my approval for my child’s participation in any and all activities prepared by Tumble Shine Gymnastics, LLC during the selected camp. In exchange for the acceptance of said child’s candidacy by Tumble Shine Gymnastics, LLC ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Tumble Shine Gymnastics, LLC . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Tumble Shine Gymnastics, LLC . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.

I fully understand that Tumble Shine Gymnastics, LLC staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the Tumble Shine Gymnastics, LLC staff to render temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the Tumble Shine Gymnastics, LLC staff to call our doctor and to seek medical help, including transportation by a Tumble Shine Gymnastics, LLC staff member and or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for the said child should the Tumble Shine Gymnastics, LLC staff deem this to be necessary. We the staff of Tumble Shine Gymnastics, LLC. recognize our obligation to make our students and their parents fully aware of the inherent risks and hazards associated with the sport of gymnastics, dance, and cheerleading, and that these students may suffer injuries, possibly minor, serious or catastrophic in nature due to the inherent hazards and risks with the above sports. Given the distinct possibility of injuries associated with the performance of these activities the Tumble Shine Gymnastics, LLC insists that all students and their parents agree to abide by all of the safety rules and policies of the Tumble Shine Gymnastics, LLC in regard to this matter. Tumble Shine Gymnastics, LLC it’s coaches and other staff members, whether paid or volunteer, will not accept responsibility for injuries sustained by any student during the course of gymnastics, tumbling, dance, cheerleading instruction, open workouts, or birthday parties, or in the course of any exhibition, competition, or clinic in which he or she may participate or while traveling to or from the event.

I further acknowledge, understand, appreciate, and agree that my participation may result in 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. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of others, and assume full responsibility my family and my child’s participation and exposure.

I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage that I consider adequate for both my child’s protection and my own protection.

I also understand that it is the parents’ responsibility to warn the child about the dangers of gymnastics and injury. The parent should warn the child according to what the parent feels is appropriate. The Tumble Shine Gymnastics, LLC will only warn the child through “safety messages” and our teaching style and progressions.

By signing below, I state that I fully understand the information contained in the waiver as well as the rules and policies of Tumble Shine Gymnastics, LLC.
Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the {Organization} . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Transportation Section

"This Release, Waiver and Indemnity Agreement (“Release”) is entered into by and between Tumble Shine Gymnastics, LLC and {athletesName} Participant’s parent(s) and/or guardian(s), namely {name} .

Whereas Tumble Shine Gymnastics, LLC offers after school services and programs related to among other things, gymnastics, tumbling, and dancing (“After School Programs”) Whereas, Tumble Shine Gymnastics, LLC offers vehicular transportation from participants school or child care center to the Tumble Shine Gymnastics, LLC facility at 60 Old Wallaceton Road, Berea Kentucky. (“Transportation Program”) The Transportation Program also includes traveling to and transporting other participants enrolled in the After School Programs from their schools or child care centers to the Tumble Shine Gymnastics, LLC facility at 60 Old Wallaceton Road Berea Kentucky. Whereas, Tumble Shine Gymnastics, LLC requires participants to execute a release and waiver of liability and indemnity agreement to participate in the Transportation Program. Whereas, Participant and Custodians agree to execute this Release so that Participant may participate in the Transportation Program. Now, therefore, in consideration of Participant participating in the Transportation Program, Participant and Custodians, for and on behalf of themselves and Participant and for and on behalf of Participant’s estate, executors, administrators, personal representatives, heirs and next of kin, acknowledge, agree and represent that they:HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUEMarylen Kagan Watson, Tumble Shine Gymnastics, LLC or their heirs, successors or assigns or their members, managers, officers, directors, agents employees, contractors, subcontractors, agents, partners, affiliates and insurers, and all other related persons, firms, companies or corporations, or drivers, owners or lessees of any vehicles used for the Transportation Program, and each of them, all for the purposes herein referred to as “Releasees” relating to any and all claims, demands, obligations or liabilities for injuries and/or damages in any way arising out of or related to the Transportation Program, even if resulting in death, whether caused by the negligence of the Releasees or which arises out of, or in any way whatsoever, is related to or resulting from the Transportation Program.2.) HEREBY AGREE TO INDEMNITY, SAVE, HOLD HARMLESS AND DEFEND the Releasees, and each of them, from any loss liability, damage, cost, expense (including without limitation, actual attorney fees) claim, demand, judgment or other action whether pending or threatened, which may arise out of, or in any way whatsoever, be related to or resulting from the Transportation Program.3.) HEREBY ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to the negligence of the Releasees or that which may arise out of, or in any way whatsoever, be related to or resulting from the Transportation Program. The undersigned expressly acknowledge and agree that the Transportation Program provided by Releases could be dangerous and involve the risk of serious injury and/or death and/or property damage. The undersigned further expressly agrees that the foregoing Release, Waiver, and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the law of the Commonwealth of Kentucky and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAVE READ AND VOLUNTARILY SIGN THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made
Please choose your summer camp package below:

Summer Camp Registration *

Registration Secure your child's spot for camp

$ 39.00

Total

$ 0.00

Credit Card

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

Policies & Proceedures

Credit Card