Open Gym Waiver

Open Gym Waiver

Date Of Open Gym*
Name of individual participating in open gym*
First Last
Name of additional individuals participating in open gym
Parent or guardian name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Phone Number*
Hold Harmless Agreement*
The undersigned, in consideration of participation in this program, agrees to indemnify, defend, hold harmless and release Miss Maria’s Dance, Cheer & Gymnastics, Inc., its officers, directors, instructors, employees and/or assigns, from any and all direct or indirect liabilities, injuries and/or death, costs, damages and reasonable attorneys’ fees, which may be suffered by the below named individual registered in this program arising out of or in any way connected with participation in the program including parties and special events.
- I agree
Today's Date*
MM slash DD slash YYYY
Number of Children
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

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