Did anyone refer you to our gym? _________________They receive $10.00 towards their tuition.
How did you hear about us?_____________________________
I fully understand that the staff of A Flip Zone, Inc. are not physicians or medical practitioners of any kind. With that in mind, I hereby release A Flip Zone, Inc. 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 A Flip Zone, Inc.
INITIALS X_________________I understand to keep my preferred class day and time that next pay period tuition for the next term will be due before the first class of the next payment period. If payment is not made before the first class of that payment period, waiting list people will be called and openings for new students will become available in place of your spot. PARENT/GUARDIAN SIGNATURE: X_______________
WAIVER OF LIABILITY – ASSUMPTION OF FULL RESPONSIBILITY FOR ALL RISKS OF
BODILY INJURY, DEATH OR DAMAGES
As a parent or legal guardian of (
CHILD’S NAME)______________ , I hereby consent to his/her participation in gymnastics, tumbling and trampoline, dance, birthday parties, special events & activities including inflatables, camps and any and all other programs offered by A Flip Zone, Inc. I understand that participation in gymnastics, trampoline, dance, and any and all other activities at A Flip Zone, Inc. 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, trampoline, dance, birthday parties, special events & activities including inflatables, camps, and any and all other activities offered by A Flip Zone, Inc. and the possibility of injury from participating in the aforementioned activities. In consideration for allowing my child to participate in activities offered by A Flip Zone, Inc., 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 Chad or Kim Dressen, A Flip Zone, Inc. or any agent, employee, representative or other acting on their behalf and to indemnify, defend and hold harmless Chad or Kim Dressen, A Flip Zone, Inc. 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 A Flip Zone, Inc. It is also my intent to release Chad or Kim Dressen, A Flip Zone, Inc. and any agent, employee, representative or other acting on their behalf from liability for ordinary 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 WAIVER OF LIABILITY has been read by me and understood completely and signed voluntarily. I am 18 years of age or older.
Date_____________________
PARENT/GUARDIAN SIGNATURE____________________
NOTE:
If someone other than yourself accompanies your child to class they need to sign under additional participant’s signature.
By signing this I understand that even though I am not taking gymnastics and/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 A Flip Zone, Inc. 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 also includes outside the building in the parking lot and all surrounding areas. By your attendance in class, you are granting your permission for you and your child to be filmed, videotaped, audiotaped or photographed by any means and are granting full use of your likeness, voice and words without compensation.
Has the parent/participant accompanying the child out into the gym had any recent surgeries or injuries? _____________________________________________________________