Youth Registration
Event Address: 7723N Janesville Avenue, Hayward, WI 54843
Contact us at (715) 558-5024 or malnouriegymrage@gmail.com
Email address *
Participants Name *
Your answer
Age *
Your answer
Parent/Guardian Name *
Your answer
Email *
Your answer
Phone# *
Your answer
Emergency Contact & Ph# *
Your answer
Health Conditions/Injuries/medical notes/allergies
Your answer
Physical restrictions
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I understand that refunds will only be provided if there is a cancellation within a minimum of one-week advance notice to the start date. Once the session has started, refunds will not be provided. *
Required
On occasion, participants may be photographed or video recorded during training by the Malnourie GymRage. I provide consent for the use of these on social media or promotional material produced or published by the Malnourie GymRage. *
Required
Participant authorizes The Malnourie GymRage to obtain medical care for, or transport him/her to a medical facility or hospital if, in the opinion, medical attention is required and participant is unable to make such decisions for himself/herself. Participant agrees to pay all costs associated with such medical care and related transportation and shall defend, indemnify and hold harmless The Malnourie GymRage of and from the consequences of such decision and from any such costs incurred relating to the provision of medical care. *
I the legal guardian of the above named participant; give our permission for our child to participate in the Malnourie GymRage's youth fitness program. We assume all risks and hazards incidental to such participation. We do hereby, release, resolve, indemnify the Malnourie GymRage, its coaches and persons involved from any claims arising from injury. We also understand that the Malnourie GymRage does not carry primary accidental or liability coverage for their participants. *
Your answer
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