Sapphire 

Gymnastics Academy

 

 

 Registration Form

Student’s Name:                                                              DOB:                          

Student’s Name:                                                              DOB:                          

Student’s Name:                                                              DOB:                          

 

Parent(s) Name(s):                                                                                                         

 

Street Address:                                                                                               

City:                                                     Zip:                            

Home Phone:                                                   

Business Phone:                                      Business Name:                                               

Mom’s Cell:                                                     Dad’s Cell:                                                      

E-mail (mandatory for all cheerleaders):                                                                          

Emergency Contact:                                                           Relationship to child:                           

Home Phone:                                                    Cell Phone:                                                      

Please list any medical conditions of which we should be aware:                                                                                                                                                                                                                                                                                                                                     

CAUTION – ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY – READ BEFORE SIGNING!

 

Name of child(ren):                                                                                                                                                               

Name of parent(s):                                                                                                                                                                 

I (we) recognize that despite all reasonable precautions implemented for safety, potentially severe injuries including permanent paralysis or death can occur in any activity involving height or motion, including, but not limited to gymnastics, tumbling, trampoline and cheerleading.  I (we) knowingly and willingly assume all such risks and therefore I consent to the aforementioned person and/or myself participating in Sapphire Gymnastics Academy, L.L.C’s programs.  Consequently I (we) hereby for myself, heirs, executors and administrators, do waive and release any and all rights and claims for damages against members, operators, coaches and other members of Sapphire Gymnastics Academy, L.L.C. from personal injury or accident of any sort or nature suffered by myself or my child by reason of participation or membership in classes, lessons or any programs or activities of Sapphire Gymnastics Academy.  In addition, I hereby give permission to trained medical professionals to administer emergency medical treatment to my child(ren) should sickness or accident occur in my absence. 

 

Parent or Guardian X                                                                                                                                                            

Date: