Gymnastics Enrollment Form

Parent's Full Name:*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Post Code

E-mail*

example@example.com

Phone Number*

Format: (000) 000-0000.

Child's Full Name*

First NameLast Name

Date of Birth:*

Date

Age in Years*

School Grade*

FemaleMale

Notes to Admin:

What Day will you attend?

Tuesdays-Beginner/intermediate-715-815 pm- Ages 6 and up-

Thursday- Beginner/intermediate- ages 6 and up- 715-815 pmWednesday- 4 and 5 year olds 5-6 pm- note time changeWednesday- ages 6 and up- 715-815 pm2 and 3 year olds- Wednesdays 615-7-waitlisted, watch email for overflow class information.

ASSUMPTION OF RISK • WAIVER OF LIABILITY • MEDICAL AUTHORIZATION MINOR CHILD -I represent that I am the parent or legal guardian of _____________________ (my “Minor Child”), who desires to voluntarily partic-ipate in programs and activities of Cheetah Kidz Gymnastics, LLC (“CheetahKidz”), and I hereby consent for him or her to partici-pate in any such programs and activities. I represent to Cheetah Kidz that my Minor Child is in good health and good physical condi-tion to participate in such programs and activities. I recognize that severe injuries, including permanent paralysis or death can oc-cur in programs or activities involving height or motion, including but not limited to gymnastics, tumbling, trampoline, dance, andcheerleading. I acknowledge that there may be other risks either not known to me or my Minor Child or not readily foreseeable atthis time, and I fully accept and assume all such risks and all responsibility for injuries, losses, and damages he or she incurs as aresult of his or her participation in Cheetah Kidz programs and activities. Being fully aware of these potential risks of injury, loss,and damage, I hereby, on behalf of my Minor Child accept all risks and costs associated with his or her participation in Cheetah Kidzprograms and activities.n consideration for the participation of my Minor Child, I hereby, for myself, my Minor Child and my/his/her respective heirs andsuccessors, covenant not to sue and forever release Cheetah Kidz , Landlord-Millington Community Schools, its officers, directors,shareholders, employees, contractors, volunteers, and program participants (“Releasee(s)”) from all liability, claims, demands, loss-es, or damages on my Minor Child’s account, caused or purported to be caused, in whole or in part, by the negligence of any Re-leasee. I further agree that if I (or any other parent or legal guardian of my Minor Child) make a claim against any Releasee that iswithin the scope of this release, I will reimburse such Releasee for any cost and expense incurred (including court costs and reason-able attorney fees) in the defense of such claim. In the event of an accident or emergency, I hereby authorize the transportation ofmy Minor Child to a hospital or urgent care facility for medical treatment, and I hold all Releasees harmless for any activities relat-ed to such transportation. I hereby specifically agree to be responsible for all medical expenses that my Minor Child may incurwhile participating in programs and activities of Cheetah Kidz .I hereby grant Cheetah Kidz permission to use my Minor Child’s likeness (via photograph, video, or other media) in any of its publi-cations and in any other media, whether now known or hereafter existing, in perpetuity, and for any other use by Cheetah Kidz Iwill make no monetary or other claim against Cheetah Kidz for the use of my Minor Child’s likeness. I have read this release andfully understand its contents. I am aware this is a release of liability on behalf of me and my Minor Child and a contract betweenCheetah Kidz and me and sign it of my own free will.