G Y M N A S T I C S CITY

 

                                   
                                         Printable Registration Form & Waiver      

 



Last Name:___________________________________________________________________________

Address _______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________
                    Town                                                                            State                           Zip Code
                                                                                                  

Home Phone #:(_________)______________________________________________


e-mail address:_________________________________________________________

e-mail address:_________________________________________________________
 

Child # 1___________________________________________________________ Class Day & Time:__________________________
                    Name
                                                                                                                    Age_______    Date of Birth___________________________   

Child # 2___________________________________________________________ Class Day & Time:__________________________
                    Name
                                                                                                                    Age_______    Date of Birth___________________________  

Father's Name:____________________________ Cell #:(___   )_____________________ Work Phone (___    )__________________                                                                                          

Mother's Name:___________________________ Cell #:(___   )______________________ Work Phone (  ____)__________________
                                                                                             
                                                                                                                                           
Emergency Name:___________________________________________(other than parent)  


Phone#:(______   )_________________________________                                 Bill To: (if other than parent)

Name:___________________________________________________________________________________________________  

Address:_________________________________________________________________________________________________  
                                  Town                                                                 State                  Zip Code

List any problems (health, physical) that your child may have that the instructors should know about:

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

 have read and understand all the rules and policies of Gymnastics City, Inc. and signed the waiver and release form.                                                     
A $55 non-refundable Registration Fee must accompany this form. (Please download next page for waiver and release form.)

DATE:______________________ PARENT SIGNATURE:_________________________________________________________   

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         Office Use Only:
DATE__________AMOUNT________ CASH OR CHECK #_________COMPUTER_____SHEETS______

NOTES:____________________________________________________________________________                    
Revised 10/01/09

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     G Y M N A S T I C S   CITY  

      2121   Crompond Road   Cortlandt Manor, New York 10567

 
           GYMNASTICS CITY WAIVER AND RELEASE FORM

I fully understand that the Gymnastics City staff members are not physicians or medical practitioners of any kind.  With the above in mind, I hereby release the Gymnastics City staff members to render temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the Gymnastics City staff members to seek medical help, or call a doctor,  including transportation by a Gymnastics City staff member and or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the Gymnastics City staff deem this to be necessary.

Child #1's Name:___________________________________         DOB:_______________

Child#2's Name:___________________________________         DOB:_______________

Parent or Guardian Signature:____________________________        Date: _______________

We, the staff of Gymnastics City recognize our obligation to make our students and their parents aware of the risks and hazards associated with the sport of gymnastics, tumbling, cheerleading, and dance.  Students may suffer injuries, possibly minor, serious, or catastrophic in nature.  Gymnastics, Tumbling, and Cheerleading can be dangerous and can lead to injury.

Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and the coaches' instructions.  They should also understand the possible dangers and possible injuries involved and that it is the parents' responsibility to warn the child about the dangers and injury.  The parent should warn the child according to what the parent feels is appropriate.  Consequently, Gymnastics City, its coaches and other staff members, will not accept responsibility for injuries sustained by anyone during the course of any gymnastics, tumbling, cheerleading open workouts, or other physical activities, or in the course of any exhibition, competition, or clinic in which he or she may participate or while traveling to or from any event.  Gymnastics City will only warn the child through safety messages, and our teaching style and progressions.  

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With the above in mind, I am fully aware of and appreciate the risks of possible catastrophic injury, paralysis, and even death, as well as other damages and losses associated with participation in gymnastics, tumbling, and cheerleading or any physical activity. 

I also affirm that I now have and will continue  to provide  proper hospitalization, health, and accident insurance coverage which I consider adequate for both my child's protection and my own protection.  I herby verify by my signature below that I fully understand and accept each of the above conditions permitting my child to participate in any activities at Gymnatics City. 

Parent or Guardian Signature: ___________________________________________________________