Little Stars Gymnastics Waiver

Please fill out the following form.

Child's Name

Parent/Guardian Name

Relationship to Child

Email

Child's Date of birth

Month

Day

Year

Address

Phone

I agree that my child can be in photos/videos to be used on website and to be sent for weekly updates to parents

I agree that my child will not bring food into the bus

I agree that my child will not bring sharp objects into the bus

I agree that no pens/markers will be brought into the bus

I agree that nobody over the age of 10 will play on gymnastic equipment

I agree that there will be an adult present at all times that there are children in the bus

I agree that if something is damaged, I will let the employee know at the time of pick up

I agree that if a child is hurt because of gymnastic equipment, I will contact Starr Allen and report a claim

I declare that the info I’ve provided is accurate and complete.

Important information

If equipment is damaged beyond repair, you will pay up to a $200 fee to replace items.
If your child is hurt in the bus, you are able to use the first aid kit in the front of the bus.
If the equipment is a result of injury, please immediately contact Starr Allen (435-849-1969) to report a claim.

Signature

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