Registration Form

I would like to:

Contact Information

Emergency Contacts

(In case Parents/Guardians above cannot be reached)

Medical Insurance Information

Physician’s Information

Waiver and Release of Liability

I, the undersigned, represent that I am the parent/legal guardian of the Gymnast and have the legal right to make decisions regarding the health, welfare and care of the Gymnast. I acknowledge, agree and accept that the Gymnast’s participation in the Rhythmic Stars LLC Rhythmic Gymnastics program (the “Program”) poses certain risks. I acknowledge and agree that:

  1. Activities offered by the Program include active sports, physical activities and use of apparatuses and equipment which can result in injury to participants and/or spectators.
  2. The risk of injury to the Gymnast from the activities involved in this Program is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
  3. I for myself, spouse, and the Gymnast, knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of others, and assume full responsibility for the Gymnast’s participation in this Program; and,
  4. I willingly agree to comply with the Program’s procedures, protocols and customary terms and conditions for participation. If I know of or have any concern for the safety and health of the Gymnast and/or the Gymnast’s readiness for participation in the Program, I will notify the nearest Program official immediately of such concern and if such concern is not satisfactorily addressed, I have the right to remove the Gymnast from this Program; and,
  5. At any time during the Gymnast’s participation in the Program, including before, during, or after a class, practice, private lesson, competition or a performance, I hereby give Rhythmic Stars LLC my permission to use its discretion in determining whether the Gymnast requires medical attention and, if so, to use its discretion in transporting the Gymnast, selecting a health care facility and obtaining medical treatment for the Gymnast.
  6. I for myself, my spouse, the Gymnasts, and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release and hold harmless Rhythmic Stars LLC; its, owners, instructors, employees, agents, volunteers, other participants, and servants, and if applicable, owners and lessors of the premises used in connection with this Program, with respect to any and all personal injury, disability, death, or loss of damage to person or property incident to the Gymnast’s involvement or participation in this Program. This includes the results of any negligence arising out of or in the course of or in any way related to the Gymnast’s use of the facilities, equipment, apparatus or premises where the Program operates and/or mine or the Gymnast’s participation in any class, program, competition or other event organized, run and/or sponsored by Rhythmic Stars LLC, whether at its facilities or elsewhere.

On behalf of myself and the Gymnast, I agree to indemnify and hold harmless Rhythmic Stars LLC, its owners, instructors, employees, agents, volunteers, other participants, and servants from any and all claims, damages, demands, costs, expenses and compensation arising out of or in the course of or in any way related to any personal injury to me or the Gymnast.