School's Out Registration - Smoky Mountain Sk8way & Fun Zone

School's Out & Early Dismissal Enrollment Form & Payment Processing

Child's Name *

First

Last

Age *

Date of Birth *

Last Grade Completed *

Name of School *

Childs's Primary Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #1 Name *

First

Last

Parent/Guardian #1 Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #1 Phone *

Parent/Guardian #1 Email *

Parent/Guardian #2 Name

First

Last

Parent/Guardian #2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #2 Phone

Parent/Guardian #2 Email

Emergency Contact #1 Name *

First

Last

Emergency Contact #1 Phone *

Emergency Contact #1 Relationship to Child

Schoo's Out Administrative Policies

There are no refunds for any missed or cancelled School’s Out days. Dates can be changed, space permitting if we are notified at least 4 days before the Schools Out! day. All requests for date changes must be made via email to inso@smokymountainsk8way.com

Waiver/Release *

Participants will be released only to people listed on the pick-up authorization form. If someone other than a parent is to pick up your child, please let us know as soon as possible. If there is a change during the day, please call to let us know. All of these policies help us to ensure your child’s safety.
Late pick-up: After School closes at 6:00 p.m. each day. Please be on time to pick up your child. There will be a $10 late charge per family for each 5 minutes, or fraction thereof, after 6:00 p.m. We reserve the right to raise this fee for anyone who is consistently late. We greatly appreciate punctuality on your part.
I, the duly authorized parent or guardian of the above-named Minor “Participant”, understand that the individual and/or group skating and other physical activities conducted at Smoky Mountain Sk8way, (hereafter “Sk8way”) may involve gymnastics, tumbling, fitness, bounce house/inflatables, dance, ball sports and martial arts, as well as the use of exercise equipment, amenities and facilities owned and/or operated by the Sk8way its representatives or its contractors (collectively, the “Activities”).
I, as the parent/guardian of the below-named Minor Participant, as a condition of authorizing their participation in such Activities do hereby agree to RELEASE and DEFEND, HOLD HARMLESS, and INDEMNIFY the Sk8way, its directors, officers, agents, faculty, volunteers, employees, representatives and contractors (hereinafter “the Releasees”) from all liability, claims, expenses, fees, fines, penalties, losses, suits, proceedings, actions and costs including attorneys’ fees and court costs, including personal injury and death, resulting from or arising out of their participation in the Activities whether caused by the alleged NEGLIGENCE of the Releasees or otherwise.
I understand that the Activities in which my child will be engaged may be dangerous, and I, as their parent or guardian, voluntarily choose to assume those dangers. I also recognize that by participating in the Activities my child or ward may experience injuries including, but not limited to, death or disability, and I willfully ASSUME THOSE RISKS. I agree that THIS LIABILITY RELEASE AGREEMENT IS BINDING ON THE PARTICIPANT AND THEIR PARENTS OR LEGAL GUARDIANS, PERSONAL REPRESENTATIVES, HEIRS, AND ASSIGNS.
In the event of accident or emergency, I hereby authorize Smoky Mountain Sk8way to transport the Participant, or cause the Participant to be transported, to a medical facility for medical treatment and I agree to release, indemnify, defend and hold the Sk8way and its representatives harmless with regard to same. I hereby agree to be fully and solely responsible for all medical expenses which may be incurred as a result of the Participant’s participation in the Activities.
I understand that my child’s participation in the activities at Smoky Mountain Sk8way may be photographed, video recorded, audio recorded, or otherwise recorded. I acknowledge that the Sk8way retains the right to use such photographs, video or audio recordings or any other recording of events for publicity, advertisement or any other legitimate purpose and I hereby consent to such use.

Confirmation *

I have read and acknowledge the above administrative policies.

Signature

Clear Signature

Total

$0.00

Which School’s Out dates are you registering for?

Payment *

Card

Name on Card

Medical Information

Please provide complete, current information so we can support your child safely. Smoky Mountain Sk8way does not administer routine or over-the-counter medications. Emergency medications may be provided only when required instructions, authorization, and the medication are supplied to staff before attendance. Type “None” when a question does not apply.

Allergies and Reactions *

List food, medication, environmental, or other allergies; describe the reaction and emergency treatment. Enter “None” if not applicable.

Emergency Medications and Action Plan *

List any emergency medication your child may need, such as an epinephrine auto-injector, rescue inhaler, seizure rescue medication, or diabetes supplies. Include when it is used and provide the required action plan and authorization before attendance. Enter “None” if not applicable.

Medical Conditions and Current Care *

Include asthma, diabetes, seizures/convulsions, heart conditions, recurrent illness, or any reason the child is currently under a health care provider’s care. Enter “None” if not applicable.

Activity Restrictions, Disabilities, Accommodations, or Special Care Instructions *

Describe any physical, developmental, behavioral, mental-health, dietary, or other needs that may affect safe participation. Enter “None” if not applicable.

Is there anything you would like us to know about your child? *

Share any medical, developmental, behavioral, sensory, dietary, emotional, family, or other information that will help us care for your child safely and successfully. You may also include relevant hospitalizations or operations. Enter “None” if there is nothing additional.

Child’s Physician or Health Care Provider *

Enter the provider or practice name.

Physician or Health Care Provider Phone *

Consent for Emergency Medical Treatment *

I authorize Smoky Mountain Sk8way to obtain emergency medical treatment for my child when I cannot be reached.
I understand that Sk8way does not administer routine or over-the-counter medications.
I have provided accurate emergency medication instructions and required action plans, if applicable.

Secondary Emergency Contact

Provide the contact’s full name, relationship to the child, and at least two phone numbers when available.

Health Insurance Information

Enter the insurance provider, policy or member number, and group number. Enter “None” if the child is uninsured.

School’s Out Registration

School's Out & Early Dismissal Enrollment Form & Payment Processing

Medical Information