Dynasty Gymnastics Club Non-member Waiver Form
Please fill out this waiver form before participating in gymnastics activities such as birthday parties, private lessons and open gyms.
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
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Month
-
Day
Year
Date
Parent/Guardian's Full Name (If under 18)
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship
Please provide any relevant medical information or allergies that we should be aware of.
In case of an emergency, I give my permission for necessary first aid treatment to be administered to the participant.
*
I agree
As legal guardian of my designated student(s), I hereby consent to all student(s) participating in this facility's open gym and/or birthday parties and events. I recognize that potentially severe injuries can occur in any activity involving height or motion, including tumbling and related activities including cheerleading, tumble tramp, trampoline, stunting, pyramids, dance, gymnastics and physical activity in general. I understand that it is the express intent of all staff and personnel to provide for the safety and protection of my student(s) and, in consideration for allowing my student(s) to use these facilities, I hereby COVENANT NOT TO SUE and FOREVER RELEASE this facility, affiliated and partner companies and organizations, property owners and lessors, staff, contractors, subcontractors, teachers, coaches, owners, directors and other members involved in this facility's program(s), from all liability and for any and all damages and injuries suffered by my student(s) during instruction, supervision, and/or control during any and all classes or extra activities.
*
I agree
Signature
*
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