Stunts & Tumble Registration Form

Stunts & Tumble Registration Form
Full Name
First NameLast Name
Age
Date of Birth
MonthDayYear
Date
Gender
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
School Name
Grade/Level
T-shirt size
Extra SmallSmallMediumLargeExtra Large
Medical Information
Blood Type
Please let us know if you have any allergies, existing illnesses or any medical conditions.
Are you currently taking any medication? If yes, please provide the generic name and its purpose?

Parent/Guardian Details
Parent/Guardian Name
First NameLast Name
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Emergency Contact Details
If parent/guardian cannot be reached.
Contact Name
First NameLast Name
Phone Number

Payment Details
Fee: $80
Payment Method
CashCheckCredit Card
Acknowledgment, Authorization, and Waiver
ACKNOWLEDGMENT, AUTHORIZATION, AND WAIVER
I, acknowledge that I have voluntarily chosen to participate in the Stunts & Tumble Program organized by [Program/Organization Name]. I understand that participation in this program involves physical activities, including but not limited to stunts, tumbling, and related exercises.
Acknowledgment of Risks: I am aware that the Stunts & Tumble Program may involve inherent risks and hazards, including, but not limited to, the risk of injury, bodily harm, or property damage. I understand that the nature of the activities may require physical exertion, and I am voluntarily participating with knowledge of the risks involved.
Health and Physical Condition: I hereby certify that I am in good health and have no physical conditions or disabilities that would prevent me from safely participating in the Stunts & Tumble Program. I have consulted with a healthcare professional and obtained clearance to participate if needed.
Authorization for Emergency Medical Treatment: In the event of an injury or medical emergency during my participation in the Stunts & Tumble Program, I authorize [Program/Organization Name] and its representatives to obtain medical treatment on my behalf. I understand that efforts will be made to contact the emergency contacts listed on this form before any medical treatment is administered, but in the case of urgency, prompt medical attention will be prioritized.
Waiver of Liability: I, on behalf of myself, my heirs, executors, administrators, and assigns, hereby waive, release, discharge, and hold harmless [Program/Organization Name], its officers, directors, employees, agents, and representatives from any and all claims, liabilities, actions, or damages that may arise from my participation in the Stunts & Tumble Program.
Media Release: I grant [Program/Organization Name] the irrevocable right and permission to use photographs and/or video recordings of me taken during the program for promotional, marketing, or educational purposes without compensation.
Participant's Agreement: I have read and fully understand this Acknowledgment, Authorization, and Waiver. I acknowledge that I am voluntarily participating in the Stunts & Tumble Program with knowledge of the associated risks.
Parent/Guardian Signature
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Date Signed
MonthDayYear
Date
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Stunts & Tumble Registration Form

Medical Information

Parent/Guardian Details

Emergency Contact Details

Payment Details

Acknowledgment, Authorization, and Waiver