EmailMe Form - KIDS NIGHT OUT Online Form

KIDS NIGHT OUT Online Form

Selected Saturdays from 6pm-10pm
Children (fully potty-trained) Ages 3 - 12
KIDS NIGHT OUT REGISTRATION FORMS are required to be on file during the Sept.-Aug. season.

* CURRENT MEMBERS: A new registration form is not necessary unless your information has changed. Simply call (914) 238-4967 or e-mail gymnastics@worldcupschools.com to reserve your spot before the Saturday of the scheduled event . * If the Kids Night Out you choose is full or has to be cancelled, we will contact you as soon as possible.

* NEW MEMBERS: Call (914) 238-4967 or e-mail gymnastics@worldcupschools.com before the Saturday of the scheduled event. We will hold your spot for 24 hrs. until we receive your KIDS NIGHT OUT REGISTRATION FORM. * If the Kids Night Out you choose is full or has to be cancelled, we will contact you as soon as possible.

*If registering on the Saturday of Kids Night Out, you must call the front desk at (914) 238-4967 before submitting this KIDS NIGHT OUT REGISTRATION FORM to ensure we have sufficient staff.

* Required fields are marked with an asterisk.

Kids Night Out *
Select if you are a New Member or a Current Member making changes to your information on file.
KNO Date *
MM / DD / YYYY
Please indicate which Kids Night Out you want to attend.
Child's Name 1 *
First Last
Birth Date *
MM / DD / YYYY
Age of your child.
Any Allergies *
Enter NONE or list any allergies or special information
Child's Name 2
First Last
Birth Date
MM / DD / YYYY
Age of your child.
Any Allergies
Enter NONE or list any allergies or special information
Child's Name 3
First Last
Birth Date
MM / DD / YYYY
Age of your child.
Any Allergies
Enter NONE or list any allergies or special information
Child's Name 4
First Last
Birth Date
MM / DD / YYYY
Age of your child.
Any Allergies
Enter NONE or list any allergies or special information
Home Phone *
### - ### - ####
Home Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Health Ins. *
Health Insurance Carrier
Parent's Name *
First Last
Mother's Name or Main Guardian's Name
Parent's Cell # *
### - ### - ####
Mother's Cell Phone or Main Guardian's Cell Phone
Family Email *
Mother's e-mail or Main Guardian's e-mail
Parent #2
First Last
Father's Name or Secondary Guardian's Name
Parent #2 Cell
### - ### - ####
Father's Cell Phone or Secondary Guardian's Cell Phone
Emergency Name *
First Last
Emergency Contact other than Parent or Guardian.
Emergency # *
### - ### - ####
Emergency Phone Number other than Parent or Guardian
KIDS NIGHT OUT DATES & TIMES:

Specific program information, dates and times are located on our website at
www.worldcupgymnastics.com.
PRICING:

$40 for the 1st child; $35 for each sibling
(if registered by the Friday before Kids Night Out)

Additional $5 (if registered on the Saturday of Kids Night Out)
PAYMENT INFORMATION:
Credit Card *
AMEX
Discover
Master Card
VISA
Choose the Credit Card you wish to use.
Card Number *
Make sure your Credit Card number is correct.
Exp. Date *
MM / DD / YYYY
Enter 2 digits for the month and day; 4 digits for the year.
Special Notes
Let us know of any special information or request.
RULES/POLICIES, WAIVER/RELEASE & ACKOWLEDGEMENT:

Read below and check marked boxes to confirm.
Rules/Policies *
I understand the Rules/Policies information.
PAYMENT: No registration will be valid without payment.

CLOSURES: In the event of inclement weather or for some other emergency, the gym may have to be closed. Call (914) 238-4967 or visit our website at worldcupgymnastics.com for closure details and updates.

REFUNDS/CREDITS: No refunds will be given unless notified by the Friday before the scheduled Kids Night Out. Exceptions are only allowed with a doctor's note.

WHILE AT WORLD CUP GYMNASTICS: Parents and non-participating siblings are not allowed on the gym floor. Spectators may observe the event from the halway or the balcony. Do not call out or distract your child during the event. Children under the age of 12 who are not participating in Kids Night Out may not be left unattended on the premises, and children must be supervised at all times. Have your children obey the Gym Rules and Policies at all times. World Cup is not responsible for any lost or stolen items. Valuable items may be left with the front desk.
Waiver/Release *
I consent to the Waiver/Release information.
WAIVER: World Cup and its staff recognize our obligation to make our clients aware of the risks and hazards associated with the sport of gymnastics, tumbling, trampoline, cheerleading, Romperee, etc. World Cup Gymnastics and its staff will not accept responsibility for injuries sustained by any child, parent and/or caregiver during the course of any gymnastics activities and/or while arriving or departing or waiting anywhere on World Cup Gymnastics premises. Parents and/or caregivers should be aware of, and educate their children about the possibility of injury. Parents and/or caregivers should also encourage their children to follow all safety guidelines and World Cup staff instructions. Gymnastics can be dangerous and lead to injury. Students, parents and/or caregivers may suffer injuries, possibly minor, serious or catastrophic in nature.

Therefore, being fully aware of the risks and possibility of injury involved, I consent to have my child and/or myself participate in the programs offered by World Cup Gymnastics. I waive and release all rights and claims for damages that I or my child may have against World Cup Gymnastics and/or its representatives and staff, whether paid or volunteer. With this in mind, in the event of an injury or illness to my child or myself, and with the knowledge that World Cup staff members are not physicians or medical practitioners of any kind, I consent to the administration of temporary first aid to me and/or my child by World Cup staff if they deem necessary, contacting a doctor and/or seeking medical help, transportation by a World Cup staff member and/or its representatives, whether paid or volunteer, to any health care facility or hospital, calling 911 and/or an ambulance, etc. I also affirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage which I consider adequate for both my child's and/or my own protection. I also understand that it is my responsibility to continually remind my child about the dangers of gymnastics, tumbling, trampoline, cheerleading, Romperee, etc. injury. World Cup Gymnastics staff members will continually remind the children, parents and/or caregivers of safety guidelines during our programs, as well as post signs throughout the premises.

PHOTO RELEASE: I authorize that World Cup Enterprises LLC has the right to use all photographs or videos taken of my child or children during Kids Night Out, Special Days, camp, classes, practices, field trips, etc. for advertising or promotional materials, or on its website.
Acknowledgement *
I accept World Cup's terms and conditions.
I accept World Cup's Rules/Policies, Waiver/Release & allow my payment to be processed by World Cup administration.
Registration Date *
MM / DD / YYYY
Enter the date you submit this registration Form.
Review all information and make any necessary changes.

Make sure all information is correct before processing registration form.