iTumble & Bounce! LLC 909 Moseley St Owensboro, Ky. 42303 270-903-2685
Circle One: Parent Night Out Birthday Party Other______
Please Print
Parent or Guardian
Address
City State Zip
Email (Required)
Home Phone______Work______
Cell (Text)
Emergency Contact Relationship ______
Phone
Student Name
Birthdate Age
Medical Info
BY THE VERY NATURE OF THE ACTIVITY, TUMBLING AND TRAMPOLINING CARRIES A RISK OF PHYSICAL INJURY, NO MATTER HOW CAREFUL THE ATHLETE AND COACH ARE, NO MATTER HOW MAY SPOTTERS ARE USED, NO MATTER WHAT HEIGHT IS USED OR WHAT LANDING SURFACE EXISTS, THE RISK CANNOT BE ELIMINATED (REDUCED, BUT NEVER ELIMINATED). THE RISK OF INJURY INCLUDED MINOR INJURIES (SUCH AS BRUISES) AND MORE SERIOUS INJURIES (SUCH AS BROKEN BONES, DISLOCATIONS, AND MUSCLE PULLS). THE RISK ALSO INCLUDES CATASTROPHIC INJURIES SUCH AS PERMANENT PARALYSIS OR EVEN DEATH FROM LANDINGS OR FALLS ON THE BACK, NECK, OR HEAD.
I, the undersigned parent or guardian of the above named student, hereby consent to have the above named student participate in any and all classes, shows, programs or other events offered by or attended by iTumble & Bounce! LLC. I accept all rules associated with participating in any and all classes, shows, programs, etc. I hereby consent not to sue and waive release and forever discharge any and all right and/or claim for damages, present or the future against iTumble & Bounce! LLC, and including but not limited to its employees, officers, owners, directors, volunteers and/or any other person/persons associated with iTumble & Bounce! LLC. This waiver and release shall act as a hold harmless agreement for any and all damages that arise now or in the future against iTumble & Bounce! LLC, and including but not limited to any employees, officers, owners, directors or volunteers.
Permission for Treatment
I confirm that the above named student is in good health. I hereby authorize simple first aid and consent to x-ray exam and medical or surgical diagnosis which is deemed necessary.
Parent/Guardian Signature
Permission to photograph – iTumble & Bounce! requests your permission to use photo’s of your child taken during class, team practice, competition, performances and other special events hosted or attended by iTumble & Bounce!, LLC. These photos will be used to help promote iTumble programs and recognize accomplishment. Only photos taken at public events or scheduled group sittings will be used.
Parent or Guardian Signature ______
iTumble & Bounce! LLC 909 Moseley St Owensboro, Ky. 42303 270-903-2685
Circle One: Parent Night Out Birthday Party Other______
Please Print
Parent or Guardian
Address
City State Zip
Email (Required)
Home Phone Work
Cell (Text)
Emergency Contact Relationship ______
Phone______
Student Name
Birthdate Age
Medical Info
BY THE VERY NATURE OF THE ACTIVITY, TUMBLING AND TRAMPOLINING CARRIES A RISK OF PHYSICAL INJURY, NO MATTER HOW CAREFUL THE ATHLETE AND COACH ARE, NO MATTER HOW MAY SPOTTERS ARE USED, NO MATTER WHAT HEIGHT IS USED OR WHAT LANDING SURFACE EXISTS, THE RISK CANNOT BE ELIMINATED (REDUCED, BUT NEVER ELIMINATED). THE RISK OF INJURY INCLUDED MINOR INJURIES (SUCH AS BRUISES) AND MORE SERIOUS INJURIES (SUCH AS BROKEN BONES, DISLOCATIONS, AND MUSCLE PULLS). THE RISK ALSO INCLUDES CATASTROPHIC INJURIES SUCH AS PERMANENT PARALYSIS OR EVEN DEATH FROM LANDINGS OR FALLS ON THE BACK, NECK, OR HEAD.
I, the undersigned parent or guardian of the above named student, hereby consent to have the above named student participate in any and all classes, shows, programs or other events offered by or attended by iTumble & Bounce! LLC. I accept all rules associated with participating in any and all classes, shows, programs, etc. I hereby consent not to sue and waive release and forever discharge any and all right and/or claim for damages, present or the future against iTumble & Bounce! LLC, and including but not limited to its employees, officers, owners, directors, volunteers and/or any other person/persons associated with iTumble & Bounce! LLC. This waiver and release shall act as a hold harmless agreement for any and all damages that arise now or in the future against iTumble & Bounce! LLC, and including but not limited to any employees, officers, owners, directors or volunteers.
Permission for Treatment
I confirm that the above named student is in good health. I hereby authorize simple first aid and consent to x-ray exam and medical or surgical diagnosis which is deemed necessary.
Parent/Guardian Signature
Permission to photograph – iTumble & Bounce! requests your permission to use photo’s of your child taken during class, team practice, competition, performances and other special events hosted or attended by iTumble & Bounce!, LLC. These photos will be used to help promote iTumble programs and recognize accomplishment. Only photos taken at public events or scheduled group sittings will be used.
Parent or Guardian Signature