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REGISTRATION

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Class Portals

Catapult Movement
2023-2024
RegiSTRATION & WAIVER

Parent/Guardian's First Name

Parent/Guardian's Last Name

Street Address

State

City

Zip Code

Phone

Child #1 Name

Child #1 Date of Birth

Child #2 Name

Child #2 Date of Birth

Child #3 Name

Child #3 Date of Birth

Emergency Contact

Emergency Contact's Phone Number

If referred, who refered you?

LIABILITY WAIVER & ASSUMPTION OF RISKS. I hereby register the participant(s) for services offered by CATAPULT MOVEMENT LLC and certify that the participant is physically able to participate in this extracurricular activity. The participant fully understands the risk of the services, and the participant fully releases CATAPULT MOVEMENT LLC, its owner, director, employees, volunteers, instructors, and/or authorized members, from any and all claims of injuries, accidents, and/or losses that the participant may receive or sustain while learning, practicing, or performing techniques taught during this optional extracurricular activity.

PHOTO/VIDEO/AUDIO RELEASE. I hereby grant permission CATAPULT MOVEMENT LLC, the right to use the participant's image, in video or still, and/or the likeness and sound of the participant's voice as recorded on audio or video without payment or any other consideration. The participant understands that the image may be edited, copied, exhibited, published, or distributed, and the participant waives the right to inspect or approve the finished product wherein the likeness appears. Additionally, the participant waives any right to royalties or other compensation arising or related to the use of the image or recording. The participant also understands that this material may be used in diverse settings within an unrestricted geographic area.