Registration – ChalkBox Gymnastics

ChalkBox Registration 2023–2024

Please fill out the form below and SUBMIT.

*Required Information

Child's Name *

First

Last

Child's Age *

Child's Date of Birth *

Home Address

Primary Parent/Guardian *

First

Last

Primary Parent/Guardian Cell # *

Alternate Parent/Guardian (optional)

First

Last

Alternate Parent/Guardian Cell #

Primary Email *

Confirm Email

Secondary Email (optional)

Confirm Email

Emergency Contact *

First

Last

Emergency Contact Cell # *

Allergies

Special Needs or Medical Conditions

Health Insurance *

Name of Insured *

First

Last

Child's Gymnasts Skill Level *

Desired Class Day/Days (classes only) *

Desired Time (classes only) *

Additional comments, requests or questions?

Name of Child Participant *

First

Last

Name of Parent or Legal Guardian *

First

Last

Autopay

Drop off at ChalkBox or email to chalkboxgym@yahoo.com

ChalkBox Gymnastics Liability Waiver

Waiver of Legal Claims and Indemnification/Allocation of Responsibility for Legal Claims

ChalkBox Gymnastics and Cheer LLC will take all precautions to prevent injury and ensure every participant’s safety. Participants will be involved in physical activities that inherently involve the risk of injury. These risks include but are not limited to the following: Sprains, bruises, torn muscles, torn ligaments, broken bones, dislocated joints, partial or total paralysis, or in some cases, death. I now acknowledge full understanding of these inherent risks, and with full knowledge and understanding, assume all such risks by permitting my child to participate in these activities. I confirm that the student being registered is in good physical condition and has no physical or medical conditions which will limit, interfere with or be aggravated by the student’s participation in the scheduled activities.

I, the undersigned parent and/or legal guardian, on behalf of myself, my child and any person acquiring a right of action of behalf of my child, hereby WAIVE ANY RIGHT TO SEEK DAMAGES from or against ChalkBox Gymnastics and Cheer LLC, and its agents, employees and independent contractors, for ANY personal injuries, accidents, financial damages or other consequential damages of any kind whatsoever, arising from or related to my child’s activities at ChalkBox Gymnastics and Cheer LLC. I further knowingly release ChalkBox Gymnastics and cheer LLC, and its agents, employees and independent contractors, form any liability or damage incurred by or associated with my child’s activities at Chalkbox Gymnastics and Cheer or functions hosted or attended by ChalkBox Gymnastics and Cheer. In addition to my release, discharge and covenant to not sue, I agree to indemnify, save and hold harmless each of the releasees from all liability claims, demands, losses or damages on the minor’s account, including negligent rescue operations. If, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the releases named above, I will indemnify, save and hold harmless each of the releasees from any litigation expenses, attorney’s fees, loss liability, damage or cost incurred as the result of any such claim. I will be personally responsible for any and all of these claims and all expenses incurred by these claims.