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Parent First Name

Parent Last Name

Phone

Child First Name

Child Last Name

Child Date of Birth

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Child First Name 2

Child Last Name 2

Child Date of Birth 2

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Child First Name 3

Child Last Name 3

Child Date of Birth 3

I understand that it is my responsibility to supervise my child(ren) during MY GYM activities. In case of emergency when I cannot be reached, I authorize the staff of MY GYM to obtain whatever medical treatment deemed necessary for the welfare of my children.

I further understand and agree that I will be financially responsible for all costs incurred to treat any injuries that may occur during all MY GYM activities regardless of whether my medical insurance would cover such charges and fees. I hereby give consent to my child(ren) to participate in MY GYM activities and agree to hold MY GYM harmless from any and all liability for any injuries or damages that I or my child(ren) may suffer.

In addition, I realize that personal contact with others involves a certain degree of risk of exposure to disease-causing organisms including COVID-19. I acknowledge that My Gym cannot screen and/or monitor all such individuals. I also recognize that all adults entering the facility including myself have agreed to the My Gym Illness Policy and have self screened themselves and their child(ren) for illness at home.

Social Media Notice: I understand that MY GYM may take photos or videos of children and/or adults in the Gym. I hereby give MY GYM permission for the copyright and use of these photos or videos on MY GYM's social media websites.

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