Articles
REGISTRATION FORM ___/20___
GENERAL INFORMATION
Student LAST Name____________________________________________________________
Student FIRST Name (1) ________________ (2) _______________ (3) _________________
Birthdate ________________________________________
Mother & Father / Guardian Names ________________________________________________
Street Address _________________________________________________________________
City ____________________________ Zip Code ______________________
Phone Number (Home) ________________________(Work)____________________________
Email_______________________________________________________
Class Registered for ________________ Day ________________ Time __________________
How Did You Hear About Us: a) word of mouth b) website c) other______________________
EMERGENCY INFORMATION
Mother's Cell Phone _____________________Father's Cell Phone ______________________
Emergency Contact ______________________ Phone Number ________________________
Family Physician ________________________ Phone Number ________________________
Pre-existing Medical Conditions (e.g. allergies or chronic illnesses)
_____________________________________________________________________________
PHOTOGRAPHY AND VIDEO RELEASE
I authorize ANN ARBOR GYMNASTICS, LLC (dba CHAMPION GYMNASTICS) to use photography, video and audio recording of my child(ren) in the promotion of their gymnastics center. I understand that said images and/or voice would be used for advertising and promotional purposes in all conventional and electronic media, including but not limited to the Internet, print, radio or TV.
______ YES _____ NO
INFORMED CONSENT FORM
I hereby give my permission for the above named student (s) to participate in any and all activities at ANN ARBOR GYMNASTICS, LLC (dba CHAMPION GYMNASTICS)
Further, I authorize ANN ARBOR GYMNASTICS, LLC (dba CHAMPION GYMNASTICS) to provide emergency treatment of an injury to or illness of my child if qualified medical personnel consider treatment necessary and perform the treatment. This authorization is granted only if I cannot be reached and a reasonable effort has been made to do so.
My child and I are aware that participating in the activity mentioned above is a potentially hazardous activity. I assume all risks associated with participation in this sport, including but not limited to falls, contact with other participants, the effects of the weather, traffic, and other reasonable risks conditions associated with the sport. All such risks to my child are known and understood by me.
Signature __________________________________________ Date ____________________