My Gym Childrens Fitness Center My Gym Yorba Linda

Spooktacular Liability Waiver

RELEASE:  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 child.  I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of whether or not my medical insurance would cover such charges and fees.  I also agree to receive promotional materials from our local MY GYM, its parent company (My Gym Enterprises), and/or its affiliates.  I hereby give my consent to my child's participation in the activities of MY GYM and hereby absolve, release and hold harmless MY GYM and all of its officers, directors, shareholders, agents, representatives, attorneys, employees, owners, successors, assigns and other affiliates from any and all liability for any injuries or damages that my child may suffer in connection with the activities sponsored by MY GYM or in which my child may participate.  

 
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*Parent First Name
*Parent Last Name
*Email
*Telephone
*Child First Name
*Child Last Name
*Child Date of Birth
 
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*Child(2nd) First Name
*Child(2nd) Last Name
*Child(2nd) Date of Birth
 
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*Child(3rd) First Name
*Child(3rd) Last Name
*Child(3rd) Date of Birth
 
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*Child(4th) First Name
*Child(4th) Last Name
*Child(4th) Date of Birth
 
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*Child(5th) First Name
*Child(5th) Last Name
*Child(5th) Date of Birth
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