Forms Registration Form "*" indicates required fields Date* MM slash DD slash YYYY Child's Name First Last Age*Birth Date MM slash DD slash YYYY Gender*Class*Time* Hours : Minutes AM PM AM/PM Days* Monday Tuesday Wednesday Thursday Saturday Parent InformationName* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email Address* How did you find us?*Referred by?*Past Student?**There is a 1 time annual $50 registration fee for insurance purposes, good until the end of August. Renews September 1st. NameThis field is for validation purposes and should be left unchanged. Activity Waiver "*" indicates required fields Date of Activity* MM slash DD slash YYYY Activity* Open Gym Birthday Party Field Trip If attending a Birthday Party or Field Trip, Insert Time Here* Hours : Minutes AM PM AM/PM If attending a Birthday Party, Insert Birthday Child's Name Here*If attending the Bring a Friend activity, Insert Friends Name*Child's Name First Last Parent's Email Sex* Male Female Child's Age*Child's Birth Date MM slash DD slash YYYY Parents Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Number*Phone Number*How did you find us?*Cell/Emergency Phone*Medical, Physical or Other Concerns:*ALL CHILDREN MUST HAVE THE RELEASE FORM SIGNED BY THEIR PARENT TO PARTICIPATE. To the extent permissible by law, I/we hereby release, discharge and/or otherwise hold harmless and indemnify GymStars, LLC, it’s owners, officers, directors, employees and associated personnel, from and against any and all demands, claims and causes of action arising, directly or indirectly, from my child’s/ward’s participation in its programs. THIS RELEASE SPECIFICALLY INCLUDES ANY DEMANDS, CLIAMS AND CAUSES OF ACTION ARISING OUT OF THE PAST OR FUTURE NEGLIGIENT ACTS AND/OR OMISSIONS OF GYMSTARS, LLC, ITS OWNERS, OFFICERS, DIRECTORS, EMPLOYEES AND ASSOCIATED PERSONNEL. PHOTOGRAPH AND STATEMENTS: I AUTHORIZE USE OF MY CHILD'S VISUAL IMAGE AND STATEMENT IN SOCIAL MEDIA, NEWSLETTERS, POSTERS AND OTHER ADVERTISING.Signature*Date* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged. Health Information Form "*" indicates required fields Name* First Last Birth of Date MM slash DD slash YYYY Age*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Emergency Phone*Email* Father* First Last Employer*Phone*Mother* First Last Employer*Phone*In case of emergency, and I cannot be reached please callName* First Last Relaton*Phone Number*Permission for emergency procedureDoctor*Phone Number*GymStars,LLC Waiver and Release Form Permission Liability Waiver and Indemnity Agreement: As a parent or guardian of a participant in activities offered by GymStars, LLC, I am fully aware of and appreciate the risks associated with participation in gymnastics and cheerleading activities and events. As conditions of the participation of the student described above ('my child') in any of the programs conducted by GymStars, LLC ('GS') including but not limited to tumbling, trampoline and gymnastics. I agree to the following: I waive any claim for bodily injury, personal injury, or property damage against GS, its directors, employees, and owners or lessors of the premises and any equipment used in connection with any programs of GS, arising out of our child's participation in any of the programs of GS whether on or off GS Gymnastics premises, or travel for the purpose of participating in any such programs or events. I understand that this weaver extends to injuries incurred by any member of my family, including my child identified above, myself, or any other family member. This agreement shall remain in effect as long as and whenever our child participates in any activity related to GS. If this agreement is not effective to waive liability on behalf of our child, ourselves, or any other family member, we further agree to indemnify GS for its liability including all costs, fees, and expenses incurred in connection with such liability. Photo Release: I authorize GymStars, LLC to use my or my child's photos, video, or audio for any advertising, decorative, or promotional purpose. Authorization of Medical Care: In case of illness or injury, I accept full responsibility for any and all associated medical costs and expenses. Acceptance of Rules and Policies: I have read and understand GS rules and policies and agree to abide by them through the course of my family's involvement with the program.or emergency procedureParticipant's Name*Printed Name of Parent or GuardianPhone NumberDate MM slash DD slash YYYY Signature*CommentsThis field is for validation purposes and should be left unchanged. Private Lesson-30 minutes only $30 "*" indicates required fields Child's Name* First Last Child's Age*Parents Name* First Last Parent's Phone Number*Is Your Child Currently Taking a Class at Gymstars?* Yes No What is the Goal for This Private Lesson?*In You Own Words, Why Are You Considering a Private Lesson Over a Class?*Please Provide 3 Options for Dates and Times of Private Lesson*Please Indicate Your Preferred Coach if Applicable*Cancellations must made prior to 24 hours in advance. Non-refundable if advance notice is not given prior to 24 hours. PhoneThis field is for validation purposes and should be left unchanged. AUTO PAY Consent Form "*" indicates required fields Student Name* First Last Parents Name*Phone*I hereby authorize GymStars, LLC to charge the following credit card amounts that I may incur for tuition, registration and pro shop items. I understand that GymStars, LLC will keep this information private and confidential. This agreement is valid until cancelled by me, the card owner. AUTO PAY needs to be cancelled in writing 2 weeks prior to the next billing cycle.PAYMENTS WILL BE DRAWN ONE WEEK BEFORE THE 1st DAY OF SESSION All fields are required! Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Signature*GymStars, LLC 210 Weiss Ave. St. Louis, MO 63125 GymStars-stl.com (314) 845-6600NameThis field is for validation purposes and should be left unchanged.
