REGISTRATION & WAIVER FORM

FAMILY INFORMATION

Mother/Guardian’s Name______Employer______

Home Ph______Cell Ph______Work Ph______*E-mail ______

Father/Guardian’s Name______Employer______

Home Ph______Cell Ph______Work Ph______*E-mail ______

Address______City______State _____ Zip Code ______

Where did you hear about us?______

EMERGENCY CONTACT INFORMATION(if mother or father cannot be reached)

Emergency Contact Person ______Relationship to Child______Phone ______

CHILD’S INFORMATION

Child’s Name______Gender ____ Birth Date____/____/____ Age____

School______Grade______Health Insurance Company______

Disabilities______

Allergies______Medications______

PARTICIPATION AGREEMENT & RELEASE OF LIABILITY

  • I am fully aware of and appreciate the risks and possibility of injuries, damages, and other losses that may result from participation in gymnastics, tumbling, activities, events, choreography, programs, and other classes held at Airborne Gymnastics, LLC (hereinafter collectively “Airborne”).
  • On my own behalf and on the behalf of my representatives and heirs, I hereby voluntarily release, hold harmless, and indemnify Airborne, its officers, directors, agents, and employeesfrom any and all claims for personal injury, property damage, or wrongful death and any damages resulting there from, that may arise out of, or in any way relate to my participation in gymnastics, tumbling, activities, events, choreography, programs, and other classes involving Airborne.
  • I hereby give my consent to Airborne to provide through medical staff of its choice, customary medical/athletic training attention, transportation, and emergency medical services that may be warranted in the course of my participation in the instruction, training, and other activities of Airborne.
  • I hereby give consent to Airborne to take photographs and videos of my child(ren) to use in future advertisements, brochures, internet, and Web site.
  • I also affirm that I now have and will continue to provide proper hospitalization, health, accident insurance coverage which I consider adequate for both my child’s protection and my own protection.

I have read and understand the terms of this agreement, and I agree to be bound by its terms.

Parent/Guardian Name (Please Print)______Date ______

Parent/Guardian Signature______Date ______