Anti Gravity Membership Application

The participant…
1. Is instructed that prior to participating on any gymnastics equipment, including trampolines and/or any rebound devices, that he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the owner and instructor of such conditions.
2. Fully understands and acknowledges that: (a) There are risks and dangers associated with participation in gymnastics and tumbling activities, including but not limited to, those of bodily injury, partial and/or total disability, paralysis and death; (b) The social and economical losses and/or damages, which could be severs; (c) These risks and dangers may be caused by the negligence of the participant and/or the negligence of others, including but not limited to, the "Releases" named below; (d) There may be other risks not known to us or are not reasonably foreseeable at this time.
3. Accepts and assumes such risks and responsibility for the losses and/or damages following such injury, disability, paralysis, or death, negligence of "Releases" named below.
4. HEREBY RELEASE, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE the seller, owner, other participants, coaches, instructors, spectators, guests, officials, lessees of the premises, officers, directors, agents, and employees, all of which are referred to as "Releases", representatives, assigns, heirs and next to kin for any and all including but not limited to, death or damage to property or person(s) caused or alleged to be caused while in part by the "Releases" or otherwise.


I, the minor's parent and/or legal guardian, understand the nature of athletic activities and the minor's participant's experience and capabilities and believe the minor to be qualified, in good health and in proper physical condition to participate in such an activity. I hereby release discharge covenant not to sue, and agree to indemnify and save and hold harmless each of the "Releases" from all liability, claims, demands, losses or damages on the minor's account caused or alleged to be caused in whole or in part by the negligence of the "Releases" or otherwise, including negligent rescue operations and further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claim against any of the "Release" named above, I will indemnify, save and hold harmless each of the "Releases" from any litigation expenses, attorney fees, loss liability, damage or any cost that may incur as a result of any such claim.

I HAVE READ THE SAFETY RULES AND THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHT BY SIGNING IT, AND SIGN IT FREELY VOLUNTARILY AND WITHOUT ANY INDUCEMENT.

PARTICIPANT/PARENT SIGNATURE: _______________________
DATE: ____________

PERMISSION TO TREAT

I hereby give my permission to Anti-Gravity to summon trained medical professionals to care for my child in the event that an injury should occur in my absence.

SIGNATURE: ______________________________ DATE: _______

ATHLETE MEDICAL INFORMATION

Existing medical conditions:

Previous Physical Injuries (broken bones, back strain, etc.)



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Parent's Name

First ______________Middle _________ Last ____________

Child's Name #1
First ______________Middle _________ Last ____________
Date of Birth ________

Child's Name #2
First ______________Middle _________ Last ____________
Date of Birth ________

Child's Name #3
First ______________Middle _________ Last ____________
Date of Birth ________

Address:

Street _______________________________ Apt # ______
State _________ Zip ______________

Phone Numbers

Home ____________________ Work ________________

Who to call in case of Emergency

Name/Relationship ____________________________________
Phone number _______________________________________
Insurance Carrier ___________________________________

How did you hear about us? ____________________________

What is your email address? ___________________________

Program:
Tramp and Tumble / Dance / Martial Arts / Cheer/ Open Gym
Reg Fee:

Date: ________________________________
Class Time: ________________________________
Tuition:_____________________