DYNAMITE SPORTS
DANCE * GYMNASTICS * CHEER
SPORTS CONDITIONING
480-385-8896
REGISTRATION FORM

(Please Print)

Responsible Party (Billing Contact) ___________________________________________________Phone______________________
Email Address________________________________________________________________________
Home Address_____________________________City______________State__________Zip_________
Student(s) Name        1._________________________Age_____________  Birthday____________
                                     2._________________________Age_____________ Birthday____________
                                    3._________________________Age______________Birthday____________
  Allergies, previous injuries, or medical conditions___________________________________________________

Mother name________________________________Phone_________________Occupation___________

Father name_________________________________Phone_________________Occupation__________

Emergency Contact___________________________Relationship_____________Phone________________
Family doctor__________________________________________________________Phone_____________
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Medical Release

                                                                                                                     (Required)

Should my child(ren)_________________________, become ill or injured while participating in an authorized
Dynamite Sports Activity:
1.  I give my permission for Dynamite Sports staff members to render first-aid treatment AND/OR emergency care
to my child(ren) while in attendance at Dynamite Dance, Gymnastics, Cheer and Sports Conditioning.

2.  I hereby grant any administrative director, staff person, agent or employee of Dynamite Sports, the authority to
obtain the emergency and /or medical attention they may deem necessary.  I further authorize the above designated
to execute that consent required in connection with such advice, care, or treatment of my child.  I hereby release
said persons from and agree to indemnify them against any liability arising out of the exercise of the authority
hereby granted.

Authorized Signature___________________________Print________________________Date__________







DYNAMITE SPORTS

WAIVER OF RELEASE OF LIABILITY

In consideration of accepting this/these student(s) as members(s) of Dynamite Gymnastics, I hereby release and
covenant not-to-sue Dynamite Sports, its officers, and/or owners, and any of their employees, staff members,
contractors, landlords, or agents, the Dynamite Sports Booster Club Association and/or its members and/or
officers, from any and all present and future claims resulting from ordinary negligence on the part of Dynamite
Sports, or others listed for property damage, personal injury, or wrongful death, arising as a result of engaging
or receiving instruction in gymnastics, dance, cheer tumbling, sports conditioning, or any other activities
incidental thereto, wherever, whenever, however the same may occur.  I hereby voluntarily waive any and
all claims resulting from ordinary negligence, both present and future, that may be made by me, my family,
estate, heirs, agents, representatives, or assigns.  

Further, I understand that gymnastics, dance, cheer tumbling, sports conditioning, and related activities always
involve certain risks, including but not limited to death, serious neck and spinal injuries resulting in complete
or partial paralysis, brain damage, and serious injury to virtually all bones, joints, muscles, and internal organs,
and that mats, pits, and other safety equipment and apparatus provided for protection, including the active
participation of a coach or instructors who will spot or assist in the performance of certain skills, may be i
nadequate to prevent serious injury.  I am voluntarily allowing my child to participate in this activity with
knowledge of the risks involved and hereby agree to accept any and all inherent risks of property damage,
personal injury, or death.

I understand that this waiver is intended to be as broad and as inclusive as permitted by the laws of the
State of Arizona, and agree that if any portion is held invalid, the remainder of the waiver will continue
in full legal force and effect.  I further agree that the venue for any legal proceedings shall be within the
State of Arizona.

I have read this and fully understand that by signing this form, I am giving up legal rights and/or
remedies which may be available to me for the ordinary negligence of Dynamite Sports also known as
Dynamite Dance and Gymnastics, or any person/entity listed above. 

_________________________________    ____________    __________________________
Signature Parent (legal guardian)                       Date                       Printed Name

______________________       ______________________          ______________________
Athlete(s) Printed Name(s)

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