Back Handspring / Tumbling Clinic Registration FormIs your child currently enrolled in a class at Elite Gym?*SelectYesNoMember FormChild's Name* First Last Child's Age*Parent's Name* First Last Email* Phone*Any health problems?*SelectYesNoPlease explain.Any allergies?*SelectYesNoPlease explain.Registration will be completed once you have called the gym to make a payment.Non-Member FormChild's Name* First Last Child's Age*Birthdate*Grade*Email* Phone*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother's Name* First Last EmployerCell Phone NumberWork Phone NumberFather's Name* First Last EmployerWork Phone NumberCell Phone NumberEmergency Contact 1* First Last Relationship*Phone Number*Emergency Contact 1* First Last Relationship*Phone Number*Any health problems?*SelectYesNoPlease explain.Any allergies?*SelectYesNoPlease explain.ReleaseI hereby authorize Elite School LLC to act for me according to their best judgement in any emergency requiring medical attention. The undersigned hereby acknowledges that participation in recreational programs involves inherent risk of physical injury, catastrophic injury, or even death. The undersigned assumes all such risks and agrees to waive and release Elite School LLC, its owners, employees, and affiliates from any liability for injuries or death incurred while involved in a program on or off the premises. The undersigned also assumes all medical costs incurred as a result of such an accident. This waiver is also applicable to any transportation in the Elite vans.Please type the following. This will serve as your digital signature.Your Name* First Last Guardian For* First Last Date* Date Format: MM slash DD slash YYYY Initial - I give permission to Elite Gym to use pictures of my child to post on the Elite Facebook page and Website.*NotesRegistration will be completed once you have called the gym to make a payment.CAPTCHA
