CLASS REGISTRATION FORM

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Registration Form

 

 

Name of Student: ___________________________________________________________       M   /   F

                                               Last                                           First                                  MI

 

Address: _________________________________________________________________________

                    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:

 

  1. The nature of gymnastics involves jumping, twisting, flipping, landing, etc. and as such there is a risk of injury inherent to the sport;

  2. 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;

  3. 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.

  4. 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:______________________________________________________

 

Printed Name:____________________________________________________________________

 

Name of Child: _________________________________________    Date: ____________________