Non-Member Waiver/Registration Form

70 Weiss Ave., West Seneca, NY 14224 716-677-0338

gymnastics-unlimited.net

Non-member Waiver 2023-2024

This is for those not currently enrolled in a class but would like to participate in our open gym programs(Private Lessons, Birthday parties, indoor toddler play, open workout or open cheer)
If signing up for open workout, you have to call ahead to make sure there is space

OK

Today's Date*

MonthDayYear
Participants name*

Participant first nameParticipant last name
Participants Date of Birth*

MonthDayYear
Age:*
MaleFemale
Are you here for:*

Indoor Toddler PlayOpen workout/tumblingPrivate LessonBirthday Party
What is the birthday child's name & date and time of party?*
What is the name of the coach the private is with?*
Is participant a minor? (17yrs & under)*

YesNo

Address*

House # and Street

Street Address Line 2

City/StateState / Province

Zip
Phone Number*

Area CodePhone Number
Email Address:*
example@example.com
I am confirming that my date of birth is correct and once I turn 23 years of age, I can no longer participate. *
Please initial

Complete parent/guardian information if participant is a minor
Parent/Guardian 1: Name*
Address*

House # and Street

Street Address Line 2

City/StateState / Province

Zip
Phone #*

Area CodePhone Number
Email Address: #1*
example@example.com
Parent/Guardian 2: Name*
Phone #*

Area CodePhone Number
Email Address: #2

Emergency Contact Name: (MUST HAVE FOR ALL PARTICIPANTS)*
Name:
Emergency Phone Number*

Area CodePhone Number

HEALTH INFORMATION

All of the following statements on this page must be initialed or answered.
The Gym relies on the parent or legal guardian's judgment regarding the child's ability & health to participate in the sport/activity.
My child (or I have, if not minor) has medical insurance:*

YesNo
Does your child (or do you, if not a minor) have any behavioral, health or physical limitations/issues that may affect participation?*

NoYes

If yes. please explain*
*

If yes, by initialing/marking, you understand there is a higher risk with a pre existing condition and you choose to continue with activities at Gymnastics Unlimited / Haas Enterprises and will not hold Gymnastics Unlimited / Haas Enterprises liable for any injury that may happen.

ATHLETE'S RELEASE/PERMISSION FOR MEDICAL TREATMENT
*

Participation is entirely his or her own choice and with the understanding of risk of accidental injury involved in any activity involving unusual motion or height. If a minor, the parents acknowledge that they know of this injury risk the minor is assuming. In the event of an emergency requiring medical attention, I here by grant permission to the personnel at Gymnastics Unlimited to administer first aid and/or physician or other hospital personnel designated by the Gymnastics Unlimited to attend my son/daughter (or ward)
*

Participant attending the gym and using the facilities, does so at his or her own risk, the Gym operator, administrators, coaches & staff shall not be liable for any damage arising from personal injuries sustained by participant in or about the premises. Participant assumes full responsibility for all injuries and damages which may occur in or about the premises and he or she does hereby fully and forever release and discharge the gym operator, all associated gyms, their owners, employees, and agents from any and all claims, demands, damages, rights of action, present or future, resulting from or arising out of the participants use of the gym and/or its facilities.
*

I have read this release form regarding "open times" at Gymnastics Unlimited. I agree to follow all rules understand that there is an assumption of risk involved with participating in the sport of gymnastics. I agree not to hold Gymnastics Unlimited, its officers, agents or instructors responsible for any damages, injuries, illnesses, disabilities or even death which may occur with my association to Gymnastics Unlimited. I will give notice of any injury that may limit participation. I understand and give permission for medical treatment to initiated by Gymnastics Unlimited. I understand policies may change without prior notice, but notice will be on our website.
Please print parent/legal guardian/your name if not a minor*
signature*

Clear
date*

MonthDayYear
Date
Should be Empty:

HEALTH INFORMATION

ATHLETE'S RELEASE/PERMISSION FOR MEDICAL TREATMENT