Registration Form Download Registration Form Or Fill In Below REGISTRATION FORM Winthrop Gymnastics Academy 64 Putnam Street, Winthrop, MA 02152 (617) 846-7606 www.winthropgymnastics.com Child’s Full Name | Age | Sex | Date of Birth | Class/Day/TimeChild’s Full Name | Age | Sex | Date of Birth | Class/Day/TimeChild’s Full Name | Age | Sex | Date of Birth | Class/Day/TimeChild’s Full Name | Age | Sex | Date of Birth | Class/Day/TimeParent/Guardian’s Full Name* First Last Address Street Address City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneWork PhoneParent/Guardian's Email Emergency Contact (Name):Emergency PhoneFamily PhysicianPlease list any medical conditions or medication that we should be aware of:* Team Members must also complete a “Payment Option Form” How did you hear about us? RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT “(AGREEMENT)” In consideration of participating in the Winthrop Gymnastics Academy Program, I represent that I understand the nature of this Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the activity. I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the “releasees” named below; and that there may be other risks either now known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation in the activity. I hereby release, discharge, and covenant not to sue the Winthrop Gymnastics Academy, its respective administers, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in while or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the result of such claim. I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. PARENTAL CONSENT AND I, the minor’s parent and/or legal guardian, understand the nature of the above referenced activities and the Minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I herby Release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses or damages on the minor’s account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releases from any litigation expenses, attorney fees, loss liability, damage, or cost any Releasee may incur as the result of any claim. Date* Date Format: MM slash DD slash YYYY Name of Parent/or Legal Guardian* First Last Parent's / Legal Guardian's Agreement to Waiver I Agree By Checking the "I Agree" below you are agreeing to the conditions stated above and confirm that the information provided is true and accurate.