Registration
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Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
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- denotes required fields
Family & Contact Information
First Name:
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Last Name:
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Relationship
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Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
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Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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AK
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AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
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KS
KY
LA
MA
MD
ME
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MO
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NJ
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OH
OK
OR
PA
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TN
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VA
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WA
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Zip:
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Emergency Contact Name and Number
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Add New Student #1:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
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(format=mm/dd/yyyy)
What do you expect your child to get out of our program?:
Medical Conditions/ Disabilities:
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Allergies/Sensitivities:
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List and explain any medications/devices you or your child will have on hand during class:
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Any history of head injuries, broken bones, sprains, fainting, seizures, etc?:
*
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
What do you expect your child to get out of our program?:
Medical Conditions/ Disabilities:
*
Allergies/Sensitivities:
*
List and explain any medications/devices you or your child will have on hand during class:
*
Any history of head injuries, broken bones, sprains, fainting, seizures, etc?:
*
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
What do you expect your child to get out of our program?:
Medical Conditions/ Disabilities:
*
Allergies/Sensitivities:
*
List and explain any medications/devices you or your child will have on hand during class:
*
Any history of head injuries, broken bones, sprains, fainting, seizures, etc?:
*
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
What do you expect your child to get out of our program?:
Medical Conditions/ Disabilities:
*
Allergies/Sensitivities:
*
List and explain any medications/devices you or your child will have on hand during class:
*
Any history of head injuries, broken bones, sprains, fainting, seizures, etc?:
*
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
What do you expect your child to get out of our program?:
Medical Conditions/ Disabilities:
*
Allergies/Sensitivities:
*
List and explain any medications/devices you or your child will have on hand during class:
*
Any history of head injuries, broken bones, sprains, fainting, seizures, etc?:
*
Additional Information:
Code of Conduct
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1. Horseplay will not be tolerated.
2. Shoes are not permitted on gym floor.
3. Only registered students, with a signed consent form, are permitted on the gym floor.
4. Long hair must be securely tied back before class. If you forget a hair tie, ask us, we have unused hair-ties available.
5. Dress Code: Girls should wear a leotard, but shorts and athletic tops are okay, no cropped tops. Boys should wear athletic t-shirts and shorts. No jeans or baggy clothing.
6. No jewelry is permitted, small stud earrings are okay.
7. No food, candy, gum, or drinks are permitted on gym floor.
8. Parents/spectators are NOT permitted int he gym area while class or activity is in progress due to safety regulations, unless the participating child is under 4 years old.
9. Instructors have the right to dismiss a student from any activities or class or from the gym permanently for disruptive or unsafe behavior.
10. Parents or caretakers of students under 5 years old are required to stay in the facility during class. Children 5 and older, who are registered in class, may be dropped off with proper permission.
11. No child should ever be left unsupervised. Parents and guardians are responsible for their children while they are not in class.
12. Any medical conditions (such as allergies, asthma, seizure disorders, history or fractures or sprains, diabetes, etc), physical and or cognitive developmental or learning disabilities, speech or hearing impairments, and emotional disturbances are to be identified on the registration form along with all other necessary information. This information will be kept confidential, although the program director may request an official clearance from a doctor prior to beginning classes in certain cases. No child will ever be discriminated against based on any information ?provided; all information pertaining to each student is used to ensure we provide the best care for that athlete.
I've read the above and agree.
Assumption of Risk
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I hereby consent to his/her participation in gymnastics, dance, birthday parties, special events & activities including inflatables, camps and any and all other programs offered by Twist'N Flip Gymnastics. I understand that participation in gymnastics, dance, and any and all other activities at Twist'N Flip Gymnastics may result in unavoidable injuries including, but not limited to, muscle or other soft tissue strains, sprains and tears, broken bones, and severe injuries such as paralysis, permanent disabilities, or even death from various causes, known and unknown, which include, but are not limited to, the heights of the equipment and the body during certain movements, rotation of the body, and movement of the body, in a unique environment. I am fully aware of the inherent risks involved in gymnastics, dance, karate, birthday parties, special events & activities including inflatables, camps, and any and all other activities offered by Twist'N Flip Gymnastics and the possibility of injury from participating in the aforementioned activities.
I've read the above and agree.
Medical Emergency
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I fully understand that the staff of Twist'N Flip Gymnastics are not physicians or medical practitioners of any kind. With that in mind, I hereby release Twist'N Flip Gymnastics to render first aid to my child in the event of any injury or illness, and if deemed necessary to call an ambulance which I agree to pay for. As a parent or legal guardian, I agree to provide health insurance for the minor child and/or guarantee payment of any medical expenses incurred as a result of training, performing, or participation in activities with Twist'N Flip Gymnastics.
If your child has any medical conditions (mental or physical) or medications we should be aware of, including but not limited to; breathing problems, seizures, Downs Syndrome, dizzy spells, previous neck or spine injuries or conditions, broken bones, high blood pressure, diabetes, autism, epilepsy, heart condition etc.***ALL ABOVE CONDITIONS REQUIRE A DOCTORS RELEASE claiming your child is fit enough to take "GYMNASTICS", "DANCE", and/or "CHEER".
I've read the above and agree.
Release of Liability
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In consideration for allowing my child to participate in activities offered by Twist'N Flip Gymnastics, I, my heirs and assigns, next of kin, and all others acting on my behalf agree to waive any and all rights, claims, damages, actions, causes of action or suits of any kind or nature whatsoever which I have or my child has against Twist'N Flip Gymnastics or any agent, employee, representative or other acting on their behalf and to indemnify, defend and hold harmless Twist'N Flip Gymnastics or any agent, employee, representative or other acting on their behalf for any injuries suffered as a result of engaging in those activities offered by Twist'N Flip Gymnastics. It is also my intent to release Twist'N Flip Gymnastics and any agent, employee, representative or other acting on their behalf from liability for ordinary or negligent conduct that may occur in the future and agree not to sue.
Should any part or parts of this agreement be held null and void, the balance of the agreement shall remain valid and maintain its full force and effect. This acknowledgment of risk and release of liability has been read by me and understood completely and signed voluntarily. I am 18 years of age or older.
By agreeing to this I understand that even though I am not taking gymnastics or dance lessons and will not be on the equipment I may injure myself being in the gym. I take full responsibility for my actions and agree to pay for any and all medical bills that might arise from an accident at Twist'N Flip Gymnastics. This could include, but not limited to stepping off uneven mats and twisting an ankle, broken bones, torn ligaments, spine injuries or even death. This includes outside the building in the parking lot and all surrounding areas.
I've read the above and agree.
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