Complete the form, then print and mail or fax (512-452-7875) to Crenshaws. 
CRENSHAW ATHLETIC CLUB - APPLICATION for CHILDREN'S PROGRAMS
5000 FAIRVIEW DRIVE AUSTIN, TX 78731 512-453-5551 FAX 512-452-7875
Parent Information
Mom's Name:    Dad's Name: 
Address:
City: State: Zip:    Email:
Home Phone: Wk Phone:   Cell Mom: Cell Dad:
Email Address: 
Emergency Name:    Phone Name: 
 
** Registration fees and deposits are non-transferable and non-refundable.
** Please refrain from asking for children to be grouped with siblings or friends.
 
First Child's Information
Child's Last Name:    First Name: 
Sex:   Birthdate: Current Age:
Check Program Box Term: Class Day Class Time
  Gymnastics   Parent/Tot Gymnastics (School year only)
  Tumbling  (School year only)   Gymnastic Team (By invitation only) 
  Swimming   Summer Afternoon Sports Camp
  After School Care (Highland Park, Casis & Doss)   All Day Summer Camp
  Palaestra for Preschoolers   All Day  SWITCH Camp
  Winter Break Camp   Spring Break Camp

Special Information Concerning Child: 

Second Child's Information 
Child's Last Name:    First Name: 
Sex:   Birthdate: Current Age:
Check Program Box Term: Class Day  Class Time
  Gymnastics   Parent/Tot Gymnastics (School year only)
  Tumbling  (School year only)   Gym Team (By invitation only) 
  Swimming   Summer Afternoon Sports Camp
  After School Care (Highland Park, Casis  & Doss)   All Day Summer Camp
  Palaestra for Preschoolers   All Day  SWITCH Camp
  Winter Break Camp   Spring Break Camp

Special Information Concerning Child: 

Please Complete, Read and Sign:

All precautions will be taken to prevent injuries. Simple first aid will be administered to all minor injuries and parents and/or doctors will be called when necessary. However, in the event that Crenshaws must make arrangements for emergency medical attention at the time of illness or accident, I hereby authorize Crenshaws to take my child to Dr._______________________ Address______________________________ Phone________________ or _______________________Hospital. In return for the use, today and on all future dates, of the property, facilities and services (the "Facilities") of Crenshaw Athletic Club ("Crenshaws"), the undersigned, for himself/herself, and on behalf of his/her children, heirs, assigns, and legal representatives, hereby expressly agrees to:

(1) ASSUME ANY AND ALL RISKS TO HIMSELF AND HERSELF AND/OR MY/OUR CHILDREN INVOLVED IN OR ARISING FROM OR MY USE OR MY CHILD'S USE OF OR PRESENCE UPON THE FACILITIES, INCLUDING, WITHOUT LIMITATION, THE RISK OF BODILY INJURY, PROPERTY DAMAGES OR DEATH. I/WE HEREBY AFFIRM THAT I/WE UNDERSTAND THE INHERENT HAZARDS OF ACCIDENTAL INJURY IN CONNECTION WITH ACTIVITIES OR BEING ON THE FACILITIES. I/WE UNDERSTAND THAT ANY ACTIVITY WHICH INVOLVES HEIGHT, MOTION OR WATER CREATES THE POSSIBILITY OF ACCIDENTAL INJURY. I/WE ARE FULLY AWARE OF AND APPRECIATE THE RISK OF CATASTROPHIC INJURY, PARALYSIS, AND EVEN DEATH AS WELL AS OTHER DAMAGES AND LOSSES ASSOCIATED WITH THE PARTICIPATION AT CRENSHAWS AND/OR BEING ON THE FACILITIES.

(2) RELEASE CRENSHAWS AND ALL OF ITS SUCCESSORS, ASSIGNS, SUBSIDIARIES, OFFICERS, DIRECTORS, EMPLOYEES AND AGENTS FROM, AND AGREE NOT TO SUE THEM ON ACCOUNT OF OR IN CONNECTION WITH ANY CLAIMS, CAUSES OF ACTION, INJURIES, DAMAGES, COSTS OR EXPENSES ARISING OUT OF MY/OUR OR MY/OUR CHILD'S USE OF OR PRESENCE UPON THE FACILITIES, INCLUDING, WITHOUT LIMITATION, THOSE BASED ON DEATH, BODILY INJURY OR PROPERTY DAMAGES; WHETHER OR NOT CAUSED BY THE NEGLIGENCE OR OTHER FAULT OF CRENSHAWS, OF ITS AGENTS, EMPLOYEES, OR SERVANTS, WHETHER PAID OR VOLUNTEERS.

(3) INDEMNIFY, HOLD HARMLESS, AND DEFEND, AT MY/OUR OWN COST, CRENSHAWS, ITS AGENTS, EMPLOYEES AND SERVANTS FROM ANY AND ALL LIABILITY, DAMAGES, LOSSES, CLAIMS, JUDGMENTS, COSTS OR EXPENSES, INCLUDING ATTORNEY'S FEES, WHICH IN ANY WAY ARISES FROM MY/OUR OR MY/OUR CHILD'S USE OF OR PRESENCE UPON THE FACILITIES, IRRESPECTIVE OR WHETHER SUCH LIABILITY, DAMAGES, LOSSES, CLAIMS, JUDGMENTS, COSTS OR EXPENSES WERE ACTUALLY OR ALLEGEDLY CAUSED WHOLLY OR IN PART THROUGH THE NEGLIGENCE OF CRENSHAWS OR ANY OF ITS AGENTS, EMPLOYEES OR SERVANTS, WHETHER PAID OR VOLUNTEERS.

I have read and understand this agreement. I also understand a copy of this agreement will be made available for me at my request.

________________________________________ ______________________
Signature of Parent                                             Date

HAVE YOU HAD A CHANGE IN ADDRESS IN THE LAST YEAR?             Yes______          No_______