CLASS REGISTRATION FORM
Name of Student: ___________________________________________________________ M / F
Last First MI
Street City Zip Code
Home Phone: __________________________ Date of Birth: ____________________ Age: _______
Father/Guardian’s Name: __________________________________ E-Mail: __________________
Mother/Guardian’s Name: _________________________________ E-Mail: __________________
Cellular Phone (mom): _________________________ Work Phone (mom):_________________
Cellular Phone (dad): _________________________ Work Phone (dad): __________________
Other emergency contacts:
Name: ______________________________ Relationship: ________________ Phone: _________
Name: ______________________________ Relationship: ________________ Phone:__________
General Health: _______________________ Any medical conditions we should be made aware of: ______________________________________________________________________________
Physician’s Name: __________________________________________ Phone: ________________
Dentist’s Name: ____________________________________________ Phone: _______________
Registering for: Tumble Bugs / Gym Bugs / Lt. League / Rec. Girls / Rec. Boys / Team / Tumbling / Other
Day and Time of Class:_____________________________________________________________
Previous Training (years/location):___________________________________________________
Emergency Medical Treatment Statement
I fully understand, that B & B Gymnastics Training Center, Inc. (B&B) staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the B&B staff to seek medical help, including transportation by a B&B staff member and/or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the B&B staff deem this to be necessary.
Preferred Hospital: ___________________________________ Urgent Care:__________________
** Discontinuing Classes **
I understand, that B & B Gymnastics Training Center, Inc. works with an automatic retention program (= your child’s name will stay on our class listing automatically from month to month – no need to re-register every month). For this reason we require a minimum two (2) weeks WRITTEN notice when discontinuing classes. I (the undersigned) understand, that if I fail to give the office at least two weeks written notice, I will be expected to pay for future additional classes. (Please refer to our Parent Information pamphlet.)
Parent’s Signature Date
EXPRESS ASSUMPTION OF THE RISK AND RELEASE OF LIABILITY FORM
We, the undersigned, hereby express and affirmatively state that we wish for the undersigned child to participate in gymnastics and related activities including, but not limited to, cheerleading, martial arts, Par Cour (urban stunting) and dance. This includes practice, training, meet competition, conditioning events, clinics, camps, exhibitions, parties, fundraiser events and contests.
We realize that B & B Gymnastics Training Center, Inc. (B&B) is a professional learning school, not a recreational facility. We fully understand and acknowledge the following:
The nature of gymnastics involves jumping, twisting, flipping, landing, etc. and as such there is a risk of injury inherent to the sport;
Fractures, ligament and cartilage tears, serious head and neck injuries leading to death, permanent brain damage and quadriplegia are rare; but do occur in gymnastics;
In order to minimize the risk of injury during participation and maintain a safe learning environment, rules and regulations are established and must be followed by everyone. Parents should make their children aware of the possibility of injury and encourage their children to follow all safety rules and the coaches’ instructions.
The risk of injury and aggravation of injury and other risks may adversely affect the participants’ present and future state of health, present and future achievement and opportunities in athletics and otherwise, and present and future vocational employment opportunities.
Knowing and understanding all the risks, including those mentioned herein, which we realize are not all inclusive, it is our desire that the undersigned participant proceed to participate in gymnastics and gymnastics related events despite the risk of possibility of injuries.
B&B Gymnastics Training Center, Inc. , its coaches and other staff members, will not accept responsibility for injuries sustained by any student during the course of gymnastics, tumbling, dance, martial arts, par cour, cheerleading instruction, parties, open workouts, or in the course of any exhibition, competition, or clinic in which he or she may participate or while traveling to or from the event.
With the above in mind, and being fully aware of the risks and possibility of injury involved, I consent to have my child or children participate in the programs offered by B & B Gymnastics. I, my executors or other representatives, waive and release all rights and claims for damages that I or my child may have against B & B Gymnastics, its owners, staff or other representatives, whether paid or volunteer.
In the event that the undersigned participant ever attempts to disaffirm or set aside this agreement, or institute any claims or suit against the parties hereby released, the undersigned parents and/or guardians shall indemnify, defend and hold these parties hereby released absolutely harmless from and against any and all such claims, suits, causes of actions, demands, damages, monies, costs, fees, expenses, attorney fees and judgments, which may be sought or obtained by said athlete against the parties hereby released.
I also affirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage, which I consider adequate for both my child’s protection and my own protection.
We have had the opportunity to ask questions and fully understand and appreciate the legal effect of signing this document. It is our specific understanding by signing this document, we will be giving up our right to hold any party hereby released responsible for any liability for any cause for any present, past, of future harm to the undersigned participant.
Parent or Guardian’s Signature:______________________________________________________
Name of Child: _________________________________________ Date: ____________________