Special Activities Release Form

Date of Activity:

Activity (Select One):(Required)

If attending a Birthday Party, Insert Time Here:

If attending a Birthday Party, Insert Birthday Child's Name Here:

If attending the Bring a Friend activity, Insert Friends Name:

Child's Name:(Required)

Parent's Email:(Required)

Sex:(Required)

Male

Female

Child's Age: (Must be 21 years old or younger)(Required)

Child's Birth Date:

Current Barron Student?(Required)

Yes

If not a current Barron student, please fill out the information below. Otherwise see below to sign, date & submit form)

Parents Name:

Address

Street Address City State / Province / Region ZIP / Postal Code

Home Phone:

Cell/Emergency Phone: (During this activity)

Medical, Physical or Other Concerns: (If applicable consult staff)

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 Barron Gymnastics, 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 BARRON GYMNASTICS, 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.

Please Type Your Name To As Proof Of Signature and Acceptance of the Terms of this Release Form:

Signature:(Required)

Date:(Required)

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