Happyjacks Registration Form

Name of Child(*)
Invalid Input

Age(*)
Invalid Input

Date of Birth(*)
Invalid Input

Address

Address Line 1(*)
Invalid Input

Address Line 2
Invalid Input

Town(*)
Invalid Input

Post Code
Invalid Input

Other Info / Medical Details
Invalid Input

Parent Guardian Details

Parent / Guardian Name(*)
Invalid Input

Your Email Address(*)
Invalid email address.

Telephone Number(*)
Invalid Input

Disclaimer

Disclaimer: I acknowledge that it is my duty to exercise ordinary care for the protection of my child/children, myself and others while attending Happyjacks Tumblers classes at St Anthonys Centre, Seaside, Eastbourne. I assume the risk of physical activity with my own and my childs/childrens physical condition. I have received advice from my doctor that I and my child/children are capable of physical exercise such as provided by Happyjacks SoftPlay, or I will seek such advice, or I will assume the risk of exercising for myself and my child/children without a doctor’s examination. This form continues to be effective as long as I am taking classes at Happyjacks Tumblers..
.
I take complete responsibility for my presence and that of my child/children at Happyjacks Tumblers and I will not hold Jaki Tompkins or any other instructors or Happyjacks SoftPlay responsible for any injuries or loss I or my child/children may incur as a result of my/their participation in any classes.
.
I hereby confirm that I have read and fully understand this release of liability and assumption of risk agreement, fully understand its terms, and sign it freely and voluntarily without inducement.
Name(*)
Invalid Input

Date(*)
Invalid Input

Tick Box(*)
Invalid Input

Security Question(*)
Security Question
Invalid Input

© Copyright 2017 Happyjacks