Premier Tumbling and Dance

523 Loveland Madeira Rd

Loveland, Ohio 45140
(513) 677-1240

Parent First Name *

Parent Last Name *

Parent or Guardian's Phone *

Parent or Guardian's Email *

Participant's First Name *

Participant's Last Name

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

Date of Birthday Party

****PREMIER TUMBLING & 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 & Dance Waiver.)

I accept

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

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.