Brick House Cheer, Gymnastics & Tumbling
Open Gym 7:00-9:00pm (every other Friday, dates listed below)
Parents/ Gaurdian Info:
Full Name /
*
Parent First Name
Parent Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
I am signing on behalf of a minor & Myself. You MUST be 18 years old or older to sign your own waiver.
*
I agree
Please list your children's date of birth, first and last name: (if none please put your name)
*
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Full Name
Date of Brith
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3
Please read and select all boxes below:
*
I understand and assume all risks associated with participating at Brick House Cheer Gymnastics & Tumbling. I further agree to hold the Brick House Cheer Gymnastics & Tumbling Center and its employees, representatives, coaches, volunteers, owners and agents harmless in any and all liability actions, claims or additions legal actions in connection with participation in any activities related to the Brick House Cheer Gymnastics & Tumbling Center. I am physically able to participate, and I am legally competent to understand and complete and comply with this agreement. Brick House Cheer Gymnastics & Tumbling does not carry medical insurance for its students/athletes. It is required that all students/athletes/participants be covered by their own medical insurance policy. Brick House Cheer Gymnastics & tumbling is not responsible or liable for any injuries under any circumstances. In signing this agreement, I assume all responsibility for myself/my child/athlete while on site or at any other off-site event associated with a Brick House Cheer Gymnastics and Tumbling event. I understand that Brick House Cheer Gymnastics & Tumbling has video surveillance on site indoors and outdoors for our staff’s protection and safety as well as all our students & athletes protection safety. I give permission for Brick House Cheer Gymnastics & Tumbling to make photos or videos of me/ my students/athletes and staff for social media, advertising, TV, and publicity purposes with no compensation. I have read all policies above and fully understand and will abide by these set policies. In signing this agreement, I assume all responsibility for my child/student/athlete while on site or at any other off-site event associated with a Brick House Cheer Gymnastics and Tumbling event.
I have read all policies above and fully understand and will abide by these set policies. In signing this agreement, I assume all responsibility for my child/student/athlete while on site or at any other off-site event associated with a Brick House Cheer Gymnastics and Tumbling event. *We reserve the right to review your license and/or other forms of ID to verify identity and age
*
Open Gym Dates
*
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May 1st
7-9pm
$15.00
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15.00
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