Birthday Party Registration

Parent's Name*

First NameLast Name

Child's Name*

First NameLast Name

Do you need to register more then one child?*

YesNo

Child's Name*

First NameLast Name

Child's Name

First NameLast Name

Child's Name

First NameLast Name

Do you attend another Gymnastics or Cheer Facility?*

YesNo

Which Facility?*

Which Facility?

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Heath Organization. COVID-19 is extremely contagious and is believed to spread mainly from person to person contact. As a result, federal, state, and local governments and health agencies recommend social distancing and have in many locations, prohibited the congregation of groups of people. RCGA has put in place preventative measures to reduce the spread of COVID-19;however RCGA cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending youth activities at RCGA could increase your risk and your child(ren)'s risk of contracting COVID-19.***************************************************************************************************************** By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected my COVID-19 by attending RCGA and that such exposure may result in personal injury, illness,permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at RCGA may result from the actions,omissions or negligence of myself and others, including, but not limited to RCGA employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to,personal injury,disability,and death),illness,damage,loss,claim,liability,or expense of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)'s attendance at RCGA or participation in RCGA programming. On my behalf , and on behalf of my child(ren), I herby release, covenant not to sue, discharge, and hold harmless Rock N Chalk, its employees, agents and representatives of and from the claims, including all liabilities,claims,actions,damages,costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of RCGA its employees,agents and representatives, whether a COVID-19 infection occurs before,during or after participation in any RCGA program.By signing this waiver I acknowledge that my child(ren), nor anyone in our household is showing symptoms( cough, fever, sore throat etc) of novel coronavirus/ COVID-19 within the last 14 days. We have not traveled out of state or been exposed to anyone that has within the last 14 days . My child(ren) nor myself has been exposed to anyone with COVID-19 that you are aware of. I understand that my child(ren) will be participating in activities that require them to break the 6ft suggestion but we will do our best to keep them separated.*

I fully understand that Rock N Chalk Gymnastics Academy (Hereafter RCGA) staff members are not physicians or medical practitioners of any kind. With this in mind, I hereby release the RCGA staff to render temporary first aid to my child in the event of any injury or illness and, if deemed necessary by RCGA staff, to seek professional medical help including transportation by a RCGA staff member or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child.We, the RCGA staff, recognize our obligation to make our students and their parents aware of the risks and hazards associated with gymnastics, tumbling, cheerleading, swimming, day camps, birthday parties, or field trips. Students may suffer injuries, possibly minor, serious or catastrophic in nature. Parents should make their child aware of the possibility of injury and encourage their child to follow all the safety rules and the coaches' instructions. RCGA, its coaches and other staff members will not accept responsibility for injuries sustained by any student during the course of the above mentioned activities or open workouts, special activities, exhibitions, competitions, or clinics or while traveling to or from the event.With the above in mind and being fully aware of the risks and the possibility of injury involved, I consent to have my child participate in the programs offered by RCGA. I, my executors, other representatives waive and release all rights and claims for damages that my child or I may have against RCGA or its representatives, whether paid or volunteer.I affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage, which I consider adequate for my child's and my own protection.I understand that it is the parent's responsibility to warn the child about the dangers of activity and injury. The parents should warn the child according to what the parent feels is appropriate. RCGA will only warn the child through safety rules and its teaching style and progression. *

I understand that RCGA may from time to time use my child's photo (names will be omitted) in printed materials or on their website. (If you DO NOT want your child's picture used, please notify RCGA)*

By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and Rock N Chalk Gymnastics. You are also confirming that you are the parent or legal guardian authorized to enter into this Agreement. You further agree that each use of your Rock N Chalk Gymnastics email equates to your E-Signature andconstitutes your agreement to be bound by the terms and conditions of these Disclosures and Agreement as they exist on the date of your E-Signature on this form.*

The risks include, among other things: slips and falls; colliding with others; strains, sprains, broken bones and musculoskeletal injuries including head, neck, and back injuries; cuts, abrasions, and bruises; cardiac related illness; heat exhaustion, heat stroke, and cardiac related events or illness; falling off of or being thrown from the inflatable the negligence of other visitors, participants, or other persons who may be present; equipment failure; the use of ropes, harnesses, and other equipment; being struck by other objects dislodged or thrown from above; loose and/or damaged artificial holds; abrasions from the walls, ropes, pads, or the floor; equipment failure; belay and or belayer failure; climbing out of control or beyond one’s personal limits my own physical condition, and the physical exertion associated with this activity.*

Signature- I agree to all of the above.*

Date*

Date

Thank you for coming into Rock N Chalk Gymnastics. We hope you have a great time and we hope to see you return.