TRAMPOLINE CLINIC

NAME: _______________ AGE: _________
PHONE #: _______ EMERGENCY #: ______

TOTAL AMOUNT ENCLOSED: $__________
SORRY NO REFUNDS, CREDITS OR TRANSFERS ON FEES
PLEASE RETURN THIS FORM AND FEES TO THE NWA OFFICE. SPACE IS LIMITED!

QUESTIONS? CALL (425)823-2665.

* NON-MEMBERS MUST HAVE A REGISTRATION CARD ON FILE.
*PHONE REGISTRATION ACCEPTED WITH
VISA/MASTERCARD PAYMENT.

MEDICAL AUTHORIZATION AND RELEASE
The above student(s) has my approval to participate in the back handspring
clinic organized by Northwest Aerials, Inc. I understand that like all
physical activities, participation in gymnastics & trampoline carries
with it a reasonable degree of risk and agree that neither Northwest
erials, Inc., nor its officers, directors, operators, agents or instructors
may be held liable in any way for any occurance in connection with the student’s participation in the backhandpring clinic which may result in serious injury or other damages to me, my family, heirs or assigns. In consideration of
being allowed to participate in such programs, I further personally assume
all risks in connection therewith, whether foreseen or unforeseen, and
further to save and hold harmless said corporation, its officers, directors,
operators, agents or instructors from any claim by me, my family, estate,
heirs, or assigns arising out of such participation

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS.

I AM AWARE THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND NORTHWEST AERIALS, INC., AND I HAVE SIGNED THIS OF MY OWN FREE WILL.

I, as parent or guardian of _____________________________give my
permission for him/her to participate in the backhandspring clinic
and in consideration of his/her participation, agree individually
and on behalf of him/her to the terms of the above agreement and
release of liability.
Northwest Aerials, Inc. has my permission to secure emergency medical
attention if I cannot be reached immediately.

Parent/Guardian or Student (if over 18) Signature: __________________________
Date: ___________