Tumble Over Grief Workshop

I would like to attend the Tumble Over Grief Workhop at Top Notch Gymnastics, hosted by the Ava Ever After Foundation and KinderMourn. I understand that this event is for children ages 5-13 who have a sibling, parent, or caregiver who has passed.

Note: Adults are welcome to sit in the bleachers during the event, but are not required to stay.

If you have questions about registering, please email us at info@avaeverafter.org.

Participating Child #1 Name / Age*

Child must be between the ages of 5-13.

Participating Child #2 Name / Age

Child must be between the ages of 5-13.

Participating Child #3 Name / Age

Child must be between the ages of 5-13.

Contact Person's Name*

Email*

Phone #*

Pick up Person's Name*

Phone #*

Alternate Pick Up Name

Phone #

Emergency Contact*

Phone #*

Food allergies

We will be providing snacks and an ice cream bar, so please let us know if there are any allergies that we need to be mindful of.

Comments

Please feel free to share anything that we may need to know about the participant that was not captured above. If you are registering more than 3 children, please include Name and Age in this field.

How did you hear about the event?

Photo Authorization

I give authorization for the Ava Ever After Foundation, KinderMourn, and Top Notch gymnastics to use photos or quotes from my child pertaining to the event. I understand that in such usage, my child's name will never be disclosed publicly in any form.

I understand that it is my responsibility to coordinate pick up for my child(ren) by the closing time of the event. I understand that the person picking up will be required to come inside the building and will be required to show a form of ID.

Contact's Signature*

Date*

LIABILITY WAIVER

Since gymnastics has the potential to be dangerous, we require all participants to assume all risks bysigning this document.

The participant who signs this document agrees:

I, prior to participating in the above activity, have inspected the facilities and equipment to be used andbelieve them to be safe, and am satisfied with the condition of the facilities and equipment. If anythingis unsafe, I will immediately advise Top Notch of the condition and refuse to participate.

I fully understand and voluntarily accept that:

a. There are risks and dangers associated with participation in the above activity which couldresult in bodily injury, partial and/or total disability and death.

b. I have no physical or mental condition which would interfere with my ability to participate inattend any such event or activity, or that would endanger my health or safety.

c. The social and economic losses and/or damages, which could result from those risks anddangers described above, could be severe.

d. These risks and dangers may be caused by the action, inaction, negligence or carelessness onthe part of Top Notch Gymnastics or any of its officers, agents, servants or employees

e. There may be other risks not known to us or not reasonably foreseeable at this time.

In consideration of permitting the participant(s) above to enroll in and participate in gymnastics by TopNotch Gymnastics, in the city of Concord, County of Cabarrus, and State of North Carolina beginning the 1 day of January 2003, the undersigned agrees, for himself/herself, his or her family his/her heirs, executors, administrators and assigns, and voluntarily releases, discharges and promises not to sue Top Notch or any of its offices, agents, servants or employees for any and all claims for personal injury, property damages or wrongful death occurring to himself/herself arising out of engaging, (or receiving instruction) in said activity or any activities incidental there to wherever or however it may occur and for whatever period the activities or instructions may continue and whether it caused by the negligence or carelessness, or otherwise, of the persons or entities mentioned above.

The undersigned further agrees, for himself/herself, his/her family, his/her heirs, executors, administrators and assigns, that in the event any claims for personal injury, property damage or wrongful death, shall be prosecuted against Top Notch Gymnastics or any of its officers, agents, servants or employees, he/she shall indemnify, save and hold harmless the same Top Notch Gymnastics or any of its officers, agents servants or employees for any and all claims by whomever or wherever made for personal injuries, property damages or wrongful death whether caused by the negligence, carelessness, or otherwise, of the persons or entities conducting or sponsoring the event.

I further agree and promise to hold harmless and indemnify Top Notch Gymnastics or any of its officers, agents, servants or employees from all defense costs, including attorney's fees, or from any other costs incurred in connection with claims for personal injury, property damage or wrongful death which I may negligently or intentionally cause to other third parties in the course of participation in this activity.

If any portion of the agreement is held invalid, it is agreed that the balance thereof shall continue in full legal force and effect.

It is the intention of the signee by this document to relieve Top Notch Gymnastics or any officers, agents, servants or employees from any responsibility from personal injury, property damage or wrongful death whether caused by negligence, carelessness, or otherwise, of the persons or entities mentioned above.

I UNDERSTAND 1AM ASSUMING ALL RISKS INHEREST IN GYMNASTICS WHETHER KNOWN OR UNKNOWN, AND THAT BY SIGNING THIS DOCUMENT I AM GIVING UP MY RIGHT TO SUE TOP NOTCH GYMNASTICS WHETHER CAUSED BY THE NEGLIGENCE OF SAID PERSONS OR ENTITIES.

I VOLUNTARILY SIGN MY NAME EVIDENCING MY ACCEPTANCE OF THE ABOVE PROVISIONS and further agree that oral representation, statements or inducements apart from this agreement have been made.

I HAVE READ THIS DOCUMENT, I UNDERSTAND IT IS A RELEASE.

Guardian E-Signature*

Date*

Date

Witness E-Signature

Date

Top Notch Gymnastics, Inc., 4380 Triple Crown Dr., Concord, NC 28027, (704)721-0727