Kids Night Out
    

For Children 2 to 8 Years Old
  
     
 
Child Registration
 
 

Child #1 Information

Child's Name:

Child's Age:

Child's Date of Birth:

Male/Female:


Food Allergies?:

Dietary Restrictions?:

Medicine Allergies?:

Medical Conditions?:

Activity Restrictions?:
 
Child # 2 Information

Child's Name:

Child's Age:

Child's Date of Birth:

Male/Female:


Food Allergies?:

Dietary Restrictions?:

Medicine Allergies?:

Medical Conditions?:

Activity Restrictions?:


Best Number to Reach You at When Your Child is With Us:

Alt. Number

Child's Doctor:

Doctor's Number:

Emergency Contact Other than Listed Above:

Relationship:

Emergency Contact Number:

By submitting this online registration form you are accepting our liability waiver stated below:

I understand that a risk is involved with participation in gymnastics and related activities which requires adherence to all rules of Dizzy's Tumblebus & Bus Stop. I, the undersigned parent/guardian, release Dizzy's Tumblebus & Bus Stop, its officers, instructors and coaches from all responsibilities and all claims for injuries received while participating or practicing gymnastics and its related activities. In the event of an emergency, I hereby give permission to the staff at Dizzy's Tumblebus & Bus Stop to administer basic first aid and/or CPR until emergency services arrive.