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Dynamite Gyms Ages 10+ Waiver
This release form is required for unaccompanied minors ages 10 to 17 to participate in an Open Gym session at Dynamite Gyms (Dynamite Gymnastics Center, The Agility Center, Bolt Parkour & Freerunning Academy, or Dynamite2/The Agility Zone).

All children attending open gym MUST have a waiver signed by a parent or legal guardian.

ALL FIELDS ON THIS FORM ARE REQUIRED.
Email address *
At the conclusion of the Open Gym session (CHOOSE ONE): *
Today's Date *
MM
/
DD
/
YYYY
Parent/Guardian Name *
Your answer
Parent/Guardian phone number *
Your answer
Parent/Guardian e-mail address *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
This waiver applies to the following children, all of whom are at least 10 years of age (please list each child's first and last name for whom this waiver applies and for whom you have the legal right to sign this release): *
Your answer
Acknowledgement of e-signature *
Required
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