REGISTRATION FORM

Child's Full Name:

Age:

Birthdate:

E-Mail Address:

Home Phone:

Cell Phone:

Work Phone:

Mailing Address:

Both Parent's Names:

Class Enrolling In:

Class Day and Time:

EMERGENCY CONTACT: Name and phone no.

Liability release

BY CLICKING THE SUBMIT BUTTON BELOW, I, AS PARENT/LEGAL GUARDIAN OF THE CHILD LISTED ABOVE, APPROVE AND GIVE MY PERMISSION FOR HIM/HER TO BE A STUDENT AT MY LITTLE GYM. I ALSO UNDERSTAND THAT HIS/HER PARTICIPATION IN GYMNASTICS / DANCE / CHEERLEADING ACTIVITIES INVOLVES MOTION, ROTATION AND WEIGHT IN A UNIQUE ENVIRONMENT AND, AS SUCH, CARRIES WITH IT A REASONABLE ASSUMPTION OF RISK OF CATASTROPHIC INJURY.  I WILL BE RESPONSIBLE FOR ANY AND ALL HOSPITALIZATION, MEDICAL OR EMERGENCY TREATMENT BY PROVIDING PROPER INSURANCE COVERAGE, OR WILL ASSUME THE COST DUE TO INJURY. I WILL NOT HOLD MY LITTLE GYM OR ANY OF ITS STAFF RESPONSIBLE IN ANY WAY FOR SUCH COSTS WHICH MAY OCCUR. I HAVE REVIEWED THE RULES AND POLICIES OF MY LITTLE GYM AND UNDERSTAND THAT HE/SHE IS RESPONSIBLE FOR HIS/HER ACTIONS WHILE PARTICIPATING IN ALL GYM ACTIVITIES. IN CASE OF AN EMERGENCY, MY LITTLE GYM'S STAFF HAS MY PERMISSION TO REQUEST MEDICAL ATTENTION FOR MY CHILD. I WILL NOTIFY MY LITTLE GYM IN WRITING ONE MONTH PRIOR TO WITHDRAWING FROM A CLASS OR LEAVING THE GYM. OTHERWISE I WILL BE HELD RESPONSIBLE FOR ANY AND ALL CHARGES INCURRED UNTIL SUCH NOTICE IS RECEIVED BY MY LITTLE GYM.

Email: MyLittleGyms@gmail.com