EmailMe Form - BIRTHDAY PARTY WAIVER

Who's Birthday *

First Last

Enter Birthday Child's Name

Party Date *

MM / DD / YYYY

Enter Birthday Party Date and Start Time

Party Day/Time *

Select Birthday Party Day/Time

Guest's Name 1 *

First Last

Enter your 1st Guest's Name

Age *

Select your 1st Guest's Age

Guest's Name 2

First Last

Enter your 2nd Guest's Name if applicable

Age

Select your 2nd Guest's Age if applicable

Guest's Name 3

First Last

Enter your 3rd Child's Name

Age

Select your 3rd Guest's Age if applicable

Guest's Name 4

First Last

Enter your 4th Guest's Name if applicable

Age

Select your 4th Guest's Age if applicable

Parent/Caregiver's Name *

First Last

Parent's Name or Caregiver's Name

Home Address *

Street Address City State / Province / Region Postal / Zip Code

Home Phone *

### - ### - ####

Parent/Caregiver's Cell #

### - ### - ####

Parent's Cell Phone or Guardian's Cell Phone

Family Email *

Parent's e-mail or Caregiver's e-mail

Emergency Name *

First Last

Emergency Contact other than Parent or Caregiver

Emergency # *

### - ### - ####

Emergency Phone Number othet than Parent or Caregiver

Special Notes

Let us know of any special information or request.

RULES/POLICIES, WAIVER/RELEASE & ACKOWLEDGEMENT:

Read below and check marked boxes to confirm.

Rules/Policies *

I understand the Rules/Policies information.

CLOSURES: The gym may be closed due to inclement weather or some other reason. Call (914)238-4967 or visit our website for closure details and updates at worldcupgymnastics.com.

BIG GYM PARTIES Ages 4 and up: Only BDay child's Parents/Guardian are allowed on the gym floor. Guests are asked to observe the Party from the balcony. Do not call out or distract your child during the Birthday Party.

LITTLE GYM (Romperee) PARTIES: Parents/Guardian are required to participate in the Party.

Children under the age of 12 who are not participating in the Birthday Party may not be left unattended on the premises, and children must be supervised at all times. Have your children obey the Gym Rules and Policies at all times. World Cup is not responsible for any lost or stolen items. Valuable items may be left with the front desk.

Waiver/Release *

I consent to the Waiver/Release information.

WAIVER: World Cup and its staff recognize our obligation to make our clients aware of the risks and hazards associated with the sport of gymnastics, tumbling, trampoline, cheerleading, Romperee, etc. World Cup Gymnastics and its staff will not accept responsibility for injuries sustained by any child, parent and/or caregiver during the course of any gymnastics activities and/or while arriving or departing or waiting anywhere on World Cup Gymnastics premises. Parents and/or caregivers should be aware of, and educate their children about the possibility of injury. Parents and/or caregivers should also encourage their children to follow all safety guidelines and World Cup staff instructions. Gymnastics can be dangerous and lead to injury. Students, parents and/or caregivers may suffer injuries, possibly minor, serious or catastrophic in nature.

Therefore, being fully aware of the risks and possibility of injury involved, I consent to have my child and/or myself participate in the programs offered by World Cup Gymnastics. I waive and release all rights and claims for damages that I or my child may have against World Cup Gymnastics and/or its representatives and staff, whether paid or volunteer. With this in mind, in the event of an injury or illness to my child or myself, and with the knowledge that World Cup staff members are not physicians or medical practitioners of any kind, I consent to the administration of temporary first aid to me and/or my child by World Cup staff if they deem necessary, contacting a doctor and/or seeking medical help, transportation by a World Cup staff member and/or its representatives, whether paid or volunteer, to any health care facility or hospital, calling 911 and/or an ambulance, etc. I also affirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage which I consider adequate for both my child's and/or my own protection. I also understand that it is my responsibility to continually remind my child about the dangers of gymnastics, tumbling, trampoline, cheerleading, Romperee, etc. injury. World Cup Gymnastics staff members will continually remind the children, parents and/or caregivers of safety guidelines during our programs, as well as post signs throughout the premises.

PHOTO RELEASE: I authorize that World Cup Enterprises LLC has the right to use all photographs or videos taken of my child or children during Birthday Parties, special days, camp, classes, practices, field trips, etc. for advertising or promotional materials, or on its website.

Acknowledgement *

I accept World Cup's terms and conditions.

I understand World Cup's Rules/Policies and consent to the Waiver/Release.

Review all information and make any necessary changes.

Make sure all information is correct before submitting this Permission to Participate form.

Submission Date *

MM / DD / YYYY

Enter the date you submit this Permission to Participate form.