REGISTRATION AND LIABILITY WAIVER FOR PARTICIPATION IN
WEEKEND RFK CLASSES
Name of Child: ___________________________________________ Age _______ DOB: ________________
Sibling: _________________________________________________ Age _______ DOB: ________________
Sibling: _________________________________________________ Age _______ DOB: ________________
Member: ____
Non-Member: ____
(Non-members are required to pay a one-time $50 Registration Fee per 10 week session and
MUST register in person)
Please check off each individual class you are registering for below:
(1) TEN Week Session: $250
SATURDAY
___ 10:30am – 11:00am Sprouts 18-24mos
___ 11:00am – 11:30am Sprouts 24-36mos
___ 10:00am – 10:45am Beg. Gymnastics 5&6
___ 10:45am – 11:30am Beg. Gymnastics 3&4
___ 11:30am – 12:15pm Beg. Gymnastics 5&6
___ 12:15pm – 1:00pm Int. Gymnastics 7 and up
___ 1:00pm – 1:45pm OPEN Gymnastics 5 and up
NUMBER OF SESSIONS PURCHASED: _______________
SESSIONS TOTAL: $____________________
>>>>>> Please see other side>>>>>>>
Name of Parent/ Guardian: _______________________________________ Member: ____ Non-Member: ____
Mailing Address: ___________________________________________________________________________
__________________________________________________________________________________________
If you are a member, would you like us to use your card on file? YES ____ Card Type __________ NO _____
Email Address: ____________________________________________Phone #: _________________________
Is your child currently on any medication or under a physician’s care, or does your child have any allergies or
limitations that may require attention? If so, please explain.
__________________________________________________________________________________________
Emergency Contact: ______________________________________ Phone #: ___________________________
Liability Waiver: I hereby agree that as a participant of Results for Kids at Results Gym that my son/daughter is in good
health and has my permission to participate in the Results Gym, Results for Kids. I shall not hold Results Gym, Results for
Kids the events sponsors, its directors, employees and facilities responsible for any loss, theft, claim, injury, damage or
liability incurred during the entirety of this program. I am waiving any rights I have to bring a legal action to assert a claim
against Results Gym, Results for Kids and/ or event sponsors, agents, and employees for negligence of Results Gym, Results
for Kids and/or event sponsors, agents and employees. I assume no responsibility and Results Gym, Results for Kids will
not be held liable for any injuries, illness or accident during class resulting in medical, dental or other expenses.
Signature: ______________________________________________ Date: _______________________
This registration and liability waiver must be filled out completely and submitted to
Courtney Connors prior to the start of any Results for Kids class.
For questions or more information contact Courtney Connors at
[email protected]
202-234-5678 x218