Registration
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Parents Night Out / Kids Fun Night - Games (Dodge "Foam" Ball, Messy Backyard, Hide & Seek) Trampoline, Foam Pit, Rope Swing, Pizza Party, Dessert, Movie & more! Register online now to reserve your spot! $25.00 per child when registering online before the event. $30 per event at the door. If you register and do not let us know at least 24 hours before, you will be charged.
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Family Information
First Name:
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Last Name:
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Type
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Doctor/Physician
Emergency Contact
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Mother
Other
Parent
Step Father
Step Mother
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Emergency Contact Info
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Students entered below will be added to your family's account
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Student's First Name:
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Student Gender:
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Birth Date:
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Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
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Student's First Name:
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Birth Date:
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Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
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Student's First Name:
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Female
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Birth Date:
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Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Add New Student #4:
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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:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Add New Student #5:
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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:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Additional Information:
LIABILITY RELEASE, ACKNOWLEDGMENT, AND WAIVER:
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The undersigned understands, acknowledges and agrees that: (i) I am aware that the equipment, facilities, and services offered by PIONEER GYMNASTICS. involves risks, including, but not limited to, risk of bodily injury; (ii) I am making use of the equipment, facilities and services of PIONEER GYMNASTICS. of my own free will; and (iii) I ASSUME ALL RISKS ASSOCIATED THEREWITH. On behalf of myself, my heirs, I hereby release and discharge the entity that operates PIONEER GYMNASTICS. (the "Owner") and all of the affiliates, subsidiaries, employees, directors, officers, agents, landlords, representatives, successors and assigns of the Owner from any and all claims or causes of action arising out of or relating to my use of the equipment, facilities, and services of that entity, including but not limited to, those resulting from bodily injury or theft of, or loss of, or damage to, property of mine.
We do not accept responsibility for lost, stolen, or damaged valuables,cash, or personal items.
I've read the above and agree.
NEW PAYMENT POLICY
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If you register and do not let us know at least 24 hours prior to the event, you will be charged for the event regardless if you attend or not.
I've read the above and agree.
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