Please Note: Insurance is the responsibility of the customer. Only members of the same family on this form!

Name: _________________________________________ Birth date: _____/_____/_____

Name: _________________________________________ Birth date: _____/_____/_____

Name: _________________________________________ Birth date: _____/_____/_____

Home Phone #: ________________ Additional Emergency Phone #: ___________________

Address: _______________________ City: ________________ State: ________ Zip: _______

I agree that Rebound Gymnastics, LLC along with employees, agents, officers and directors of this organization will not be liable for any losses or damages occurring as a result of our families participation in the sport of gymnastics or other activities held at Rebound Gymnastics, LLC except where such loss or damage is the result of intentional or reckless conduct of the organization or individuals identified above, and I hereby waive and release any and all claims which may be made against Rebound Gymnastics, LLC. Although accidents are few, I am fully aware of and understand the risks, including the risk of catastrophic injury, paralysis, even death, as well as other damages associated with participation.

As the participating adult, or parent or legal guardian of the participating children, I verify by my signature below that I fully understand and accept each of the above conditions for permitting myself or my family members to participate in activities at Rebound Gymnastics, LLC.