Tumbling Registration Form

Athlete Information

Athlete's Name

First Name Last Name

Birth Date

Month Day Year

Age

Gender

Male Female

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Parent/Guardian Information

Name

First Name Last Name

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Cell Phone Number

What specific skills are you looking to learn / improve

Informed Consent and Acknowledgement

I hereby release, discharge, and covenant not to sue Chenango Gymnastics, its respective administrators, directors, agents, officers, volunteers, employees, other participants, any sponsors, advertisers, and if applicable, owners or lessors of premises on which the activity takes place (each considered one of the "Releasees" herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence; of the "releaseess" or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver, liability, and assumption of risk, I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any litigation, expenses, attorney fees, loss, liability, damage, or cost, which may occur as a result of such claim.

Assumption of risk

In consideration of my child participating in the program at Chenango Gymnastics, I represent that I understand the nature of this activity and that my child is qualified, in good health, and in proper physical condition to participate in such activities. I fully understand that this activity involves risk of serious bodily injury, including permanent disability, paralysis, and/or death, which may be caused by their own actions, or inaction, 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 responsibility for losses, costs, and damages incurred as a result of participation in the activity.

Payments and specifics

$20 each visit (additional fee of $3 applies to credit charging)

Tumblers will be required to sign in each visit

Payment option prepay up to 4 consecutive practices which will guarantee a spot for you. *

Practices cannot be carried over if a practice is missed, 1 makeup will allowed

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.