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GYMJAM
Application CAMPER INFORMATION ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Current Gymnastics Level:__________________ Level competed this year, if applicable: ______________________ Highest All-Around this year: _________ Minimum
of Pre-team or Level 3 required Medical Insurance is required for all Campers. _______________________________________________________________________ _______________________________________________________________________ Put an X indicating what type of camper you would like
to be: Session Fee ($699 Resident/$555 Day Camper):
_________________ Please enclose Total Session Fee or a $150 Deposit. Total Session Fees minus $150 Deposit = Balance Due. Balance Due May 1, 2008. Make checks payable to GymJam. Mail to: GymJam, 26515 Ruether Ave., Santa Clarita, CA, 91350. ph:661-251-3390 f:661-251-9968 RELEASE AND CONSENT AGREEMENT The undersigned student and/parent or legal guardian of
the student (hereinafter referred to collectively and individually as
"the Student") of GYMJAM, by signing this Agreement, expressly
acknowledges that this Agreement contains a release which may operate
to shift risk and liability from GYMJAM to the Student. The Student expressly
accepts the responsibilities and duties resulting from such provisions.
The Student further acknowledges that some of the activities regularly
conducted at GYMJAM involve, as do any gymnastics activity, a risk of
injury including but not limited to injury resulting in paralysis or even
death. The individual(s) signing this Agreement have read, understand
and expressly agree to the terms contained in this Agreement. I/we, the undersigned Student and/or parent or legal guardian
of the Student of GYMJAM, for and in consideration of enrollment in GYMJAM,
hereby voluntarily and knowingly execute this release with the express
intention of releasing GYMJAM, its officers, agents, employees or servants
from any and all claims, actions, demands or rights to monetary judgment
whatsoever arising from any and all injury or physical harm which may
occur to the Student, including specifically those that may arise out
of, or be occasioned by, directly or indirectly, any negligent act(s)
or omission(s) of GYMJAM during the Studentís attendance at and
participation in any activities associated with GYMJAM both on and off
the GYMJAM premises. In addition to any gymnastics related activity, this
release is intended to and does extend to any injury or damage resulting
from transportation between housing, gym, recreation and other activities
provided by GYMJAM. MEDICAL CONSENT I, the Student and undersigned parent or legal guardian
of the Student do hereby expressly grant to the staff of GYMJAM in the
case of emergency, the authority to obtain medical assistance and treatment
as they deem necessary. I give my express permission and consent for a
licensed doctor or physician to administer the necessary aid to the Student
should he/she become injured or sick while in attendance at or while participating
in any activity associated with GYMJAM and to do so without having to
wait until a parent, a legal guardian or other relative is contacted.
I fully release GYMJAM and its officers, directors, agents, employees
and servants from any claims, actions, demands or damages resulting from
the decision to seek or the administration of medical assistance and I
understand that neither GYMJAM, its officers, agents, employees nor servants
shall be responsible for any medical expenses incurred on behalf of the
Student, and that I am responsible for all payment of medical expenses
so incurred. Executed this __________________ day of _______________________, 2008
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