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

My child can be in photos/videos to use for emails sent to parents for progress and/or advertising purposes

Yes

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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Little Stars Gymnastics - The Fun Bus -

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