Grand Rapids Gymnastics Academy

Grand Rapids Gymnastics Academy Registration Form

Student's Name______Birthdate______

Address______

City/State/Zip______

Phone______School______

Parent/Guardian Name(s) ______

Parent/Guardian Home Phone______

Parent/Guardian Work Phone______

Parent/Guardian Mobile Phone______

Parent/Guardian Email Address______

Emergency Contact Name______

Emergency Contact Phone______

Registration Fee

Grand Rapids Gymnastics Academy charges a one-time registration fee of $25 per family. Each following year, GRGA charges a $15 renewal fee per family. We ask that you include your $25 registration fee with this form when registering. These fees assist in offsetting the cost of insurance paid per student.

For a complete set of GRGA payment and gym policies, please visit www.grgymacademy.com Grand Rapids Gymnastics Academy Special Events Waiver Your child will be using gymnastics equipment at Grand Rapids Gymnastics Academy. Because there is risk involved, you must fill out and sign this form or your child will not be permitted to participate.

Child's Name______

Parent/Guardian Name______

Liability Waiver By signing below, you agree that you are aware that your child named above will be engaging in physical exercise involving sports, coordination and fitness training, which could cause injury to them. You further agree that your child is voluntarily participating in these activities and as a parent/guardian; you are assuming all knowledge of the injuries which may result from your child's participation. You hereby accept these risks and agree to waive any claims or rights that you may otherwise have to bring action or suit upon employees or owners for injuries that may occur as a result of these activities.

Parent/Guardian Signature______Date ______

Grand Rapids Gymnastics Academy Emergency Information

Known Medical Conditions/Problems (Check all that apply)

__ Nothing Known __ Asthma __ Hearing Problems __ Muscle Weakness __ Epilepsy __ Cardiac/Heart __ Diabetic __ Hemophilic __ Headache __ Special blood problems __ Wears glasses __ Wears contacts __ Nose bleeds __ Allergies (please list) ______

__ Takes medications regularly (please indicate how often)______

Does your child have any physical restrictions (if yes, what)? Are there are any special parental arrangements we should be aware of? ______

Other Adults we can Contact in Case of an Emergency:

Name ______Telephone ______

In an emergency, this information on this sheet could be imperative to the welfare of your child. Please notify the Grand Rapids Gymnastics Academy of any changes that may occur during the time your child attends the academy.

Consent to Treat

I understand that my child may be injured while participating in gymnastics at the Grand Rapids Gymnastics Academy.

I authorize the Grand Rapids Gymnastics Academy to obtain emergency care that may be necessary while participating in the Grand Rapids Gymnastics Academy's programs.

Parent/Guardian Signature______Date______

Assumption of Risk

I understand that while my child is participating in gymnastics, there is a risk of injury. I understand that such an injury can range from a minor injury to a major injury.

I hereby accept and assume the risk of injury to my child and understand the possible consequences of such injury.

Parent/Guardian Signature______Date______