Back Handspring / Tumbling Clinic Registration Form Is 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother's Name* First Last Employer Cell Phone NumberWork Phone NumberFather's Name* First Last Employer Work 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* 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 Δ
