Release Form | Emeth Gymnastics

What are you here for?*
- Classes
- Birthday Party
- Event (Open Gym, Clinic, Parent's Night Out)
- Other
Mother's Name*
First Last
Father's Name*
First Last
How many children?
Child's Name*
First Last
Child's Date of Birth*
Child's School*
Second Child's Name*
First Last
Second Child's Date of Birth*
Second Child's School*
Third Child's Name*
First Last
Third Child's Date of Birth*
Third Child's School*

Primary Contact Email*
Enter Email Confirm Email
We send important enrollment, billing and updates to this address! We keep your information safe!
May we send you our weekly email newsletter?
- Yes!
Primary Phone*
Primary Phone Description*
Secondary Phone*
Secondary Phone Description*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Emergency Contact
Emergency Contact Name*
First Last
For if you are unreachable in an emergency
Emergency Contact's Phone*
Phone Description*

Specific information we should know about your child(ren):
Please describe any special conditions Emeth staff should be aware of
Pleas list any severe allergies we should be aware of

Release of Liability:
In completing this form, I understand that even though the policies, teaching format, and progressions in the programs offered by Emeth Gymnastics are developed with a mindset of safety, there is still the risk of minor or serious injury, including death, for all participants, even when all safety precautions have been taken. I consent to have my child/children named above participate in the programs offered by Emeth Gymnastics.

I understand that Emeth Gymnastics may use photos & videos of my child/children (and myself) for recognition of accomplishments and/or for marketing purposes.

I agree to respect and follow all policies and rules of the Emeth Gymnastics program. I, my executors, and/or other representatives hereby waive and release all rights and claims for damages that I, my children, or other family members may have against Emeth Gymnastics and its representatives, whether paid or volunteer.

I affirm that I have and will continue to provide proper hospitalization, health, and accident insurance coverage which I consider adequate for both myself and my child/children’s protection. I hereby give permission for the emergency medical treatment of my child.

My signature below I certifies that I am a legal guardian of the named child(ren) on this form. I agree to all the terms stated above and am releasing Emeth Gymnastics from liability.
Terms Acceptance:*
- I Agree to the above Release of Liability
Type Your Name Here:*
First Last
Parent / Guardian Signature*
Referral Source
Comments
This field is for validation purposes and should be left unchanged.

Emeth Gymnastics Release Form

Step 1 of 4 - Basics

Emergency Contact

Specific information we should know about your child(ren):

Release of Liability: