Team Registration Parent's Name* First Last Cell Phone*Second Parent's Name First Last Second Parent's Cell PhoneMailing 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 Billing Address (if different) 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 Home PhoneEmail* Emergency Contact* First Last Emergency Contact Phone*How did you hear about us?*FriendsParty GuestInternet SearchPostcardGymnast #1Name* First Last Date of Birth (Month/Day/Year)*Gymnast's Age*Grade in School*Medical Conditions or LimitationsPlease Select Team Level*BronzeSilverGoldPlatinumDiamondPractice Days and Times (ex. M&R,6:00-8:00)*Do you need to register an additional Team Gymnast? Yes Gymnast #2Name* First Last Date of Birth (Month/Day/Year)*Gymnast's Age*Grade in School*Medical Conditions or LimitationsPlease Select Team Level*BronzeSilverGoldPlatinumDiamondPractice Days and Times (ex. M&R,6:00-8:00)*Do you need to register an additional student? (20% discount) Yes Gymnast #3Name* First Last Date of Birth (Month/Day/Year)*Gymnast's Age*Grade in School*Medical Conditions or LimitationsPlease Select Team Level*BronzeSilverGoldPlatinumDiamondPractice Days and Times (ex. M&R,6:00-8:00)*Tuition Agreement and Acknowledgment of Risk and Waiver of LiabilityBy completing this form, you agree to the policies of Gymnastic Academy of Boston-Acton, as follows: GAB-Acton assumes all of our students will continue throughout the year (Sept.-August) unless written notice of extenuating circumstances is given to the office one (1) month prior to the start of the next month. Full payment will be expected if you do not cancel your team membership. There is a non-refundable annual USAG Registration Fee per gymnast paid directly to the national sanctioning body. Tuition payments are applied via a bank EFT on the 20th of each month for the following month. A $25 fee will be applied for all EFT transactions rejected by the bank as insufficient funds. No refunds or credits will be given for missed practices, meets or instructor re-placement. I hereby grant consent and authorize the use of photographs, pictures, slides, and video of my child participating in GAB activities for commercial and art purposes in any medium of advertising, communication, publication or publicity that will promote GAB programs, and/or recognition of participants. As an adult student and/or as the parent or legal guardian of all child students listed above, I hereby give permission for our child(ren) and/or myself to participate in programs at Gymnastic Academy of Boston-Acton, LLC. I recognize that gymnastics, tumbling, parkour and ninja training are sports that involve inflatables, height and rotation of the body and there are inherent risks involved. There are also inherent risks to my being on the premises, as either an adult student or simply as a non-student parent or guardian, during such activities. These risks also specifically include the additional risk of being exposed to and/or contracting COVID-19 or other illness. On behalf of myself and my child(ren), I agree to waive all claims (including for negligence) against and agree not to sue Gymnastic Academy of Boston-Acton, LLC, or its owners, directors, officers, employees, staff and instructors for any liability, loss, cost, damage, medical expense, long-term care or emotional distress arising out of any personal injury, including total injury, paralysis and death, and including exposure to or contracting COVID-19 or other illness, which may occur to myself or any of my children while on the premises of or under the instruction, supervision, or control of Gymnastic Academy of Boston-Acton, LLC. I hereby testify to my and my child’s sound health of mind and body and I authorize Gymnastic Academy of Boston-Acton, LLC, to seek medical treatment at the nearest medical facility for myself and my child in case of emergency or injury. Agree to Terms* I have read and understand the above and agree to the above terms, including the Acknowledgment of Risk and Waiver of Liability. (please check box)
