Child Participation Form Participant (Child) Information "*" indicates required fields Participant (Child) Name* Participant/Child First Participant/Child Last GenderGender Male Female Birth Date MM slash DD slash YYYY Choose Your Activity*Choose Your ActivityOpen GymField TripBirthday PartyParent's Night OutSpecial EventDate of Event MM slash DD slash YYYY Number of Additional ParticipantsNumber of Additional Participants012345Additional Participant - 1Participant Name* Participant First Name Participant Last Name GenderGender Male Female Birth Date MM slash DD slash YYYY Choose Your Activity*Choose Your ActivityOpen GymField TripBirthday PartyParent's Night OutSpecial EventAdditional Participant - 2Participant Name* Participant First Name Participant Last Name GenderGender Male Female Birth Date MM slash DD slash YYYY Choose Your Activity*Choose Your ActivityOpen GymField TripBirthday PartyParent's Night OutSpecial EventAdditional Participant - 3Participant Name* Participant First Name Participant Last Name GenderGender Male Female Birth Date MM slash DD slash YYYY Choose Your Activity*Choose Your ActivityOpen GymField TripBirthday PartyParent's Night OutSpecial EventAdditional Participant - 4Participant Name* Participant First Name Participant Last Name GenderGender Male Female Birth Date MM slash DD slash YYYY Choose Your Activity*Choose Your ActivityOpen GymField TripBirthday PartyParent's Night OutSpecial EventAdditional Participant - 5Participant Name* Participant First Name Participant Last Name GenderGender Male Female Birth Date MM slash DD slash YYYY Choose Your Activity*Choose Your ActivityOpen GymField TripBirthday PartyParent's Night OutSpecial EventHousehold / Adult Primary ContactGuardian Name* First Last Relationship to Participant(s)*Relationship to Participant(s)MotherFatherGuardianOtherRelationship - OtherContact InformationAddress* Street Address Address Line 2 City State / ProvinceAlabamaAlaskaAmerican 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 Phone*Email* As a condition of participation for the student listed above in any programs conducted by Gymfinity Ltd. (d/b/a Gymfinity Gymnastics) I agree to waive any claim of bodily injury, or property damage. *Waive Liability* I Agree As a condition of participation for the student listed above in any programs conducted by Gymfinity Ltd. (d/b/a Gymfinity Gymnastics) I agree to waive any claim of bodily injury, or property damage.My/Our child/children has/have no physical or health conditions that would limit his or her participation in athletic activities or present a known and undue risk of transmitting any virus and/or disease to other participants in these activities. I/We hereby give permission for my/our child/children to have their temperature(s)taken before participation in activities at Gymfinity Ltd., d/b/a Gymfinity Gymnastics; participate in activities at, or with, Gymfinity Gymnastics and to work on all of the necessary equipment at the physical location of Gymfinity Gymnastics or under the charge of it's instructors. I/We understand that Gymfinity Gymnastics will keep confidential information regarding participants' temperatures and reserves the right to exclude individuals from participation in activities based on this information in accordance with its policies. I/We understand that Gymfinity Gymnastics may inform other participants of any confirmed diagnosis of COVID-19 (or other transmittable virus/disease), to the extent they may have been exposed, but will maintain confidentiality to the extent possible; I/we waive all privacy-related claims based on such disclosure(s). *COVID-19* I Agree My/Our child/children has/have no physical or health conditions that would limit his or her participation in athletic activities or present a known and undue risk of transmitting any virus and/or disease to other participants in these activities. I/We hereby give permission for my/our child/children to have their temperature(s)taken before participation in activities at Gymfinity Ltd., d/b/a Gymfinity Gymnastics; participate in activities at, or with, Gymfinity Gymnastics and to work on all of the necessary equipment at the physical location of Gymfinity Gymnastics or under the charge of it's instructors. I/We understand that Gymfinity Gymnastics will keep confidential information regarding participants' temperatures and reserves the right to exclude individuals from participation in activities based on this information in accordance with its policies. I/We understand that Gymfinity Gymnastics may inform other participants of any confirmed diagnosis of COVID-19 (or other transmittable virus/disease), to the extent they may have been exposed, but will maintain confidentiality to the extent possible; I/we waive all privacy-related claims based on such disclosure(s).I/We understand that such risks simply cannot be eliminated. I/We knowingly, voluntarily, and expressly assume the risk of, and responsibility for, injury and damages. I/We specifically agree that the employees, owners, volunteers, and other agents of Gymfinity Gymnastics (the “Released Parties”) shall not be responsible for such injuries/damages, even if caused in whole or part by the negligence or fault of the Released Parties, whether such negligence is present at the signing of this waiver or takes place in the future. This waiver and release does not apply to gross negligence or intentional torts by the Released Parties. *Waive Liability2* I Agree I/We understand that such risks simply cannot be eliminated. I/We knowingly, voluntarily, and expressly assume the risk of, and responsibility for, injury and damages. I/We specifically agree that the employees, owners, volunteers, and other agents of Gymfinity Gymnastics (the “Released Parties”) shall not be responsible for such injuries/damages, even if caused in whole or part by the negligence or fault of the Released Parties, whether such negligence is present at the signing of this waiver or takes place in the future. This waiver and release does not apply to gross negligence or intentional torts by the Released Parties. I understand the scope of this waiver includes my child, myself or any family member. *Liability Inclusion* I Agree I understand the scope of this waiver includes my child, myself or any family member.I agree this waiver will be in effect every time we participate in a Gymfinity Program. *Waiver Start* I Agree I agree this waiver will be in effect every time we participate in a Gymfinity Program.AUTHORIZATION OF MEDICAL CARE: In the case of illness or injury, if I cannot be reached, I authorize and desire medical care for my child at Gymfinity's discretion. I accept responsibility for any and all associated expenses. *Medical Care* I Agree AUTHORIZATION OF MEDICAL CARE: In the case of illness or injury, if I cannot be reached, I authorize and desire medical care for my child at Gymfinity's discretion. I accept responsibility for any and all associated expenses.I have read, understood and agree to all of the statements above. By checking here and the re-entry of my name below will constitute a legal signature. *Signature* I Agree I have read, understood and agree to all of the statements above. By checking here and the re-entry of my name below will constitute a legal signature.Re-Enter Parent/Guardian Name Here*Can Gymfinity contact you regarding other programs or information? *Can Gymfinity contact you regarding other programs or information?* Yes No FacebookThis field is for validation purposes and should be left unchanged. Δ
