Premier Tumbling and Dance

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679 Loveland Madeira Road
Loveland, Ohio 45140
(513) 677-1240

Participant's Name *

Parent or Guardian's Name *

Parent or Guardian's Email *

Parent or Guardian's Phone *

Birthday Boy or Girl's Name (Who is the birthday party for?) *

Date of Birthday Party *

YYYY

**********PREMIER TUMBLING AND DANCE BIRTHDAY PARTY WAIVER********** We, the undersigned parents/guardians of do hereby give permission for our child to participate in the above stated activity. We do understand and accept that there are inherent risks with any physical activity. We certify that he/she is physically fit to participate in the activities of the tumbling/dance birthday party. We do hereby assume full responsibility for any risk of injury due to our child’s participation in this activity. We will not hold the instructors or Premier Tumbling & Dance responsible for accident or injury. We further consent to emergency treatment by a physician in the event of injury to or illness of our child during his/her participation in such activities. *

(By checking here, you accept and agree to the Premier Tumbling and Dance Birthday Party Waiver.)

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Parent or Guardian's Digital Signature *

(By typing name, you consent to use of electronic signature in lieu of an original signature on paper.)

Today's Date *

YYYY

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