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Tumble City Registration Form
Name:_________________________________________Phone:_______________________________
__________________________________________________________________________________
Address
City
State
Zip
Date of Birth:__________________________Gender: _____Male
_____Female
Emergency Phone(s):___________________________________________________________________
Emergency
Contact:____________________________________________________________________
Name of Class or
Event:_________________________________________________________________
Day(s):_____________________________Time(s):__________________________Fee:_____________
We, the undersigned, do hereby give permission
for the above named individual to participate in the above named class or
event and acknowledge the risk herein. We understand that any
activity involving motion or movement can result in injury and therefore
acknowledge full responsibility for such risk. We hold harmless
Tumble City, Cheryl Hunter and Family, Wendy Dinkel and Family, the
property owner and the City of Yucaipa in the event of accidental injury
or death before during or after any Tumble City event or activity.
We further understand that all fees paid are non-refundable unless
otherwise determined applicable by Tumble City owners.
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signature of parent or
guardian
date signature
of parent or
guardian
date |
