Fill Out Our Online Waiver Guest's Name* Birthdate* MM slash DD slash YYYY Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent's Name* First Last Email* I am aware that participation in gymnastics involves risk and possible injury. I understand and agree that Starz Gymnastics Academy and its staff will assume NO responsibilities for injury or medical expenses incurred by my son/daughter or myself. My child (or I) has (have) no physical, mental, or emotional problems that would interfere with participation in this program. Digital Signature (First and Last Name)* Date* MM slash DD slash YYYY What to wear: T-shirt and shorts, leotard or warm-up suit is recommended. No baggy clothing, zippers, belts, buckles or jewelry. No shoes, socks are optional and long hair must be tied back. 67342
