Downriver Gymnastics

Emergency Information - Participation Agreement - Liability Release

Date of Enrollment:                                                              Updated:                               

Student’s Name:                                                                                   Age                       

Date of Birth:                                       

Father’s Name                                                      Work Phone                                         

Home Phone                                        

Father’s Mobile Phone                                                         Email Address                                                                                                               

Father’s Address                                                                 City                                         State                       Zip                         

Mother’s Name                                                    Work Phone                                          Home Phone                                        

Mother’s Address                                                               City                                         State                       Zip                         

Mother’s Mobile Phone                                                     

E-mail Address                                                           ______         

PERSON OTHER THAN PARENT TO BE NOTIFIED IN CASE OF AN EMERGENCY:

Name                                                                                                                     Phone                                                                    

Relationship to Student                                                                                                                                                                     

PARTICIPATION:

1.Readiness to Participate: The student named above is physically and mentally able to participate in all           activities associated with the class or classes they are now or will be in the future enrolled at DOWNRIVER GYMNASTICS. Fully Informed: The officers and staff of DOWNRIVER GYMNASTICS have been informed of any special physical or mental conditions that could influence the type, duration, or intensity of training the student will receive.

 Please list Allergies, Medical Conditions or Medications that could affect participation in gymnastic classes:

2. WAIVER & RELEASE: I/we are fully aware of, appreciate, and accept the risks involved in doing    gymnastics and tumbling activities including: the risk of catastrophic injury, paralysis and even death. I/we further agree that DOWNRIVER GYMNASTICS, along with its employees, agents, officers, and directors shall not be liable for any losses or damages occurring as a result of the student’s participation in this sport.

NO CASH REFUNDS - LATE FEES DUE AFTER 10^TH OF MTH OR 4^TH WEEK OF SESSION       

 2 MAKEUPS PER 10 WK SESSION - GYM       1 MAKEUP PER 5 WK SESSION - CHEER

3.  I HEREBY GIVE MY PERMISSION TO DOWNRIVER GYMNASTICS TO OBTAIN EMERGENCY     MEDICAL TREATMENT FOR MY CHILD IF DEEMED NECESSARY:

Parent or Legal Guardian Signature:                                                                                 Date                                       

How did you find out about us ?

Word of Mouth/Referred by                                                                                              Yellow Pages        Party/Field Trip Other                                                     

DG E-mail Address - downrivergymnastics@yahoo.com