Registration
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Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
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Zip:
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Emergency Contact Info
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
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:
Date of last physical:
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
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:
Date of last physical:
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
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:
Date of last physical:
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
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:
Date of last physical:
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
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:
Date of last physical:
Additional Information:
Release of Liability
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The undersigned hereby acknowledges that participation in gymnastics, Ninja Zone, and other activities offered at Yelm Gymnastics Center/Ninja Zone involves an inherent risk of physical injury. The participant attending programs at Yelm Gymnastics Center/Ninja Zone and using the facilities does so at his or her own risk. Yelm Gymnastics Center/Ninja Zone, its officers, agents, and employees shall not be held liable for any damage arising from personal injuries or property damage sustained by the participant in or about the premises. Participant assumes full responsibility for all injuries and damages which may occur in or about the premises, and for all claims, demands, damages, rights of action, present or future, resulting from the participant's use of the gym and its facilities. Participation at Yelm Gymnastics Center/Ninja Zone is voluntary, and with the understanding of the risk of accidental injury involved in this sport. I hereby authorize Yelm Gymnastics Center/Ninja Zone and its agents to act for me according to their best judgment in any emergency requiring medical attention.
I've read the above and agree.
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