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Release Form
emethgymnastics
2022-10-14T16:15:44-04:00
EmethGym Release Form
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What are you here for?
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Classes
Birthday Party
Event (Open Gym, Clinic, Parent's Night Out)
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Who is the primary guardian/contact?
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Mother
Father
Other
Primary Guardian/contact name
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First
Last
Mother's Name
First
Last
Father's Name
First
Last
How many children?
One Child
Two Children
Three Children
Child's Name
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First
Last
Child's Date of Birth
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Boy or Girl?
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Girl
Boy
Second Child's Name
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First
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Second Child's Date of Birth
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Second Child: Boy or Girl?
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Girl
Boy
Third Child's Name
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First
Last
Third Child's Date of Birth
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2018
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2016
2015
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2013
2012
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2010
2009
2008
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2005
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2001
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1991
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1989
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1987
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1982
1981
1980
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1978
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1976
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1974
1973
1972
1971
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1968
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Third Child: Boy or Girl?
*
Girl
Boy
Primary Contact Email
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Enter Email
Confirm Email
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Yes!
Primary Phone
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Primary Phone Description
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Secondary Phone
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Secondary Phone Description
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Mailing Address
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Address Line 2
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Emergency Contact
Emergency Contact Name
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For if you are unreachable in an emergency
Emergency Contact's Phone
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How is emergency contact related to student(s)?*
*
Specific information we should know about your child(ren):
Any special conditions or severe allergies Emeth staff should be aware of?
Terms & Liability Release
*
RISK.
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 (including parents participating with students), even when all safety precautions have been taken.
I consent to have the student(s) named above participate in the programs offered by Emeth Gymnastics.
SUPERVISION.
I understand that Emeth is not equipped or staffed to supervise children before or after designated class times. I will not hold Emeth responsible for any damages or injuries that might occur if my children remain at Emeth outside of designated class times without supervision.
VIRUS RISK.
I understand the although Emeth Gymnastics follows strict protocol regarding sanitation and cleanliness, due to the contagious nature of certain bacteria and viruses, including but not limited to the virus causing COVID-19, I voluntarily assume the risk that my children and/or I may be exposed to or infected by such bacteria or viruses while attending Emeth Gymnastics. I understand that such exposure or infection could result in illness, permanent disability, or death.
PHOTO RELEASE.
I understand and consent to the use of photos and/or videos of student(s) named above by Emeth Gymnastics for recognition of her/his accomplishment and for marketing purposes.
RULES & RELEASE FROM CLAIMS FOR DAMAGES.
I agree to respect and comply with all the 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, student(s) listed above, or other family members may have against Emeth Gymnastics and its representatives, whether paid or volunteer.
INSURANCE COVERAGE.
I affirm that I have and will continue to provide proper hospitalization, health, and accident insurance coverage which I consider adequate for the protection of both myself and student(s) named above.
PERMISSION FOR EMERGENCY MEDICAL TREATMENT.
I hereby give permission for the emergency medical treatment of student(s) named above.
CERTIFICATION.
My signature below 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.
I agree to the above release of liability
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(a printable release form may be found
here
)