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Registration Form
Please print, fill out, and bring with you to your first class.
Name_______________________________________________Date__________
Child's name________________________Child's approx.
age______________
Cell Phone_______________________________Email___________________________
I am registering for:
[ ] 12 class pass $144 [ ] 8 class pass $120
[ ] single class $20 How did you hear about StrollerGym?___________________________________
Terms and Conditions
*To Participate in any StrollerGym classes you must register
by calling (650)353-1100, or emailing StrollerGym@comcast.net, and bring this
signed form to your first class.
*The 12-class Pass offers any 12 classes within 4
months of issue date. The 8-class Pass offers any 8 classes within 3 months of issue date.
*We
accept cash or checks, made payable to StrollerGym.
*In the case of rain , classes will be held in the covered corridors
of the Cubberley Facility. If the weather is especially cold or rainy, class may be cancelled. Call us or visit www.StrollerGym.com
to see if class has been cancelled.
*We recommend babies be a minimum of 6 weeks old.
*There are no refunds
for any reason. We can freeze 12 or 8-Class Passes for injury or pregnancy only.
*Prices shown are valid through Dec.
31, 2011. After that date, prices are subject to change. Waiver of Liability
Voluntarily and of my own
free will, I bring myself and my child to participate in StrollerGymTM classes or personal training.I understand
that there are certain risks and hazards involved in participating in StrollerGymTM classes and personal training
that may result in injury to myself, my child, or other children and parents, including, but not limited to those hazards
associated with strenuous physical activity, weather conditions, sidewalk conditions, park conditions, equipment, and other
participants. I understand that the very nature of StrollerGymTM classes and personal training includes risks that
are not limited to: muscle strains, pulls, or tears; broken bones; shin splints; heat prostration; knee, back, or foot injuries;
heart attacks; scrapes, bruises and any other illness, soreness, injuries and/or emotional trauma or suffering. I hereby affirm
that I am in good physical condition and do not suffer from any disability which would limit or prevent my participation in
this exercise program. Further, I, by my signature and I by my signature as a parent of my child, voluntarily elect to accept
and assume all risks of injury incurred or suffered by me or my child while participating in StrollerGymTM classes
or personal training; while waiting for class to start; and while on or upon the premises of any and all of the parks or spaces
arranged for by StrollerGymTM classes. In consideration of my and my child's participation in the StrollerGym exercise
classes or personal training, I the undersigned, for myself, my child, my heirs, and assigns, hereby RELEASE FROM LIABILITY,
to INDEMNIFY AND HOLD HARMLESS, and FOREVER DISCHARGE FROM ANY AND ALL RESPONSIBILITY, the StrollerGymTM LLC, and
the following parties: owners, sponsors, officers, agents, servants, associations, employees, or any person or entity connected
with the StrollerGymTM LLC for any claim, damages, costs or cause of action which I have or may in the future have
as a result of injuries or damages sustained or incurred by me or my child from whatever cause.
I, by my signature and
I by my signature as a parent of my child, am signing this waiver
voluntarily and with complete understanding of the
terms and conditions herein.
Your signature______________________________Date_________ |
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