Special Needs Hip Hop and Gymnastics Registration Form

Welcome to Ms. Mary's GymKids Classes! The new session starts Saturday, February 8!

Unless noted, classes are held at Dancer's Workshop of Yuma located at 1335 S. Pacific Ave. in Yuma, AZ 85365. Suggested attire: Comfortable clothing the children can move and groove freely in!
I am signing up for (check all that apply):*

Slime Camp (all ages welcome!)Special Needs) Ages 3-7 Special Needs Gymnastics (Saturdays Nov. 22-Dec. 20) 9:30-10:15am $85.00(Special Needs) Ages 8+ Special Needs Hip Hop (Saturdays Nov. 22-Dec. 20) 10:15-11:00am $85.00Specialty Camp - Kids Holiday Baking Joy, Friday Nov. 28 from 10am-3pm, ages 5-12, location TBD $120.00Kids Night Out - Slime and Glow party, Friday Nov. 28 starts at 6pm until 10:00pm! Ages 5-12, location TBD $50.00Other
Student's Name*

First NameLast Name
Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Primary Phone *

Area codePhone Number
Alternate Phone *

Area CodePhone Number
E-mail*
Waiver

Participant Waiver and Release of Liability
I, the undersigned, hereby acknowledge and agree to the following terms as a condition of my child's participation in the gymnastics and/or dance classes (hereinafter referred to as the "Activity"):

Assumption of Risk
I understand that participation in the Activity involves inherent risks, including but not limited to physical injury, illness, or property damage. I voluntarily assume all risks associated with participation in the Activity.

Release of Liability
I release and hold harmless GymKids, GymKids.net LLC, Mary Hillman, Dancer's Workshop of Yuma, its employees, instructors, agents, and representatives from any and all claims, demands, or causes of action arising out of or related to my participation in the Activity, including but not limited to claims for personal injury, property damage, or negligence.

Medical Consent
In the event of an emergency, I authorize GymKids to seek medical treatment for my child and agree to bear any costs incurred as a result.

Photography/Media Release
I consent to the use of photographs or videos taken during the Activity for promotional or educational purposes by GymKids.

Acknowledgment and Agreement
By signing below, I confirm that I have read, understood, and agree to the terms of this waiver. I acknowledge that I am signing this document voluntarily and that it is legally binding.
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.
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First NameLast Name
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Welcome to Ms. Mary's GymKids Classes! The new session starts Saturday, February 8!