Name:
______________________________Age ____ Date of Birth: __________ Gender _______
Address: __________________________________City ____________________ Zip ___________
Email address: ________________________________ Home phone: _______________________
Mother’s name: ____________________________Cell #: _____________ Work #: ____________
Father’s name: _____________________________Cell #: _____________Work
#_____________
Emergency contact (other than parents)______________________________
Phone #:__________
Persons to whom child may be released _____________________________Phone
#:__________
_____________________________ Phone
#: __________
Health Insurance Company ________________________contract#
_________________________
Group # _________________Effective Date
___________Policy Holder_ ____________________
Allergies / health
problems: ________________________ Medications: _____________________
Being
the parent and/or legal guardian of _____________________________, I fully understand that the nature of gymnastics involves
jumping, twisting, flipping, landing, etc. Precautions are in place at the gymnasium to protect my child from injury but accidents,
however rare, are possible. I am wiling to assume these risks on behalf of my child. I hereby certify that my child is fully
capable of participating in gymnastics and that my child is healthy with no physical or mental disabilities that would restrict
full participation in the activities of the gymnastics and cheer programs. In addition to giving my full consent for my child’s
participation, I do hereby waive, release, and hold absolutely harmless Ingird's Gymnastics and Cheer, LLC and its coaches for any injury that may be suffered by my child,
whether the result of negligence or any other cause. I understand that Ingrid's Gymnastics and Cheer,LLC will
not be liable in any way for
medical, doctor, hospital, or dental expenses. It is my specific understanding by signing this document that all parents and
guardians of my child will be giving up the right to all claims, suits, causes of actions, demands, monies, attorneys fees
and judgments.
