<p> “A Night at the Oscars”</p><p>TeamGym Competition Saturday, February 6, 2010 Location: </p><p>10556 Industrial Ave. Roseville, CA 95678 Registration Fees: $45 TeamGym Competitors ($55 if after December 1st) $10 Double Dippers $7 Spectator Admission (5 & under Free) Deadline: December 1, 2009 Please feel free to contact us with any further questions: (916) 772-3547- Please ask for Erica [email protected] “A Night at the Oscars” Entry Form Saturday, February 6, 2010 Club Name______USAG Club #______Address:______City:______State______Zip:______Contact Person’s Name:______Coach (if different)______Gym: (___)___-____ Fax: (___)___-____ Cell: (___)___-____ E-mail:______</p><p>Fee Quantity Total TeamGym Participants $45 TeamGym Double Dips (Competing on more than 1 team) $10 Grand Total______</p><p>THERE IS A $7 ENTRY FEE FOR SPECTATORS! Please fill out and mail the following information no later than December 1, 2009 We look forward to seeing you!</p><p>Please feel free to contact us with any further questions at: [email protected] (916)772-3547-Please ask for Erica</p><p>Please do not send a check for each family- Submit ONE check per club! Please make checks payable to: Flip-2-It Sports Center 10556 Industrial Ave. Roseville, CA 95678 TEAM GYM Club Name______Club #______</p><p>Team Name # of Athletes # of Females # of Males Level</p><p> This is a sanctioned meet.  Boys and co-ed teams will be competing by level only. There will be no separation. COACHES Coach Name USAG # Membership Exp. Date Safety Certification Date</p><p>Equipment you plan to bring:______</p><p>Please do not send a check for each family- Submit ONE check per club! Please make checks payable to: Flip-2-It Sports Center 10556 Industrial Ave. Roseville, CA 95747 Team Gym Athletes</p><p>Gymnast Name USAG # Release Form Level Team Name Total Due 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 10556 Industrial Ave., Ste 130 Roseville, CA. 95765 www.flip2itsportscenter.com [email protected] Student Information</p><p>Child Name: Sex: Age: D.O.B. Child Name: Sex: Age: D.O.B. Address: City: Zip: Home Ph.: ( ) Mom's Name: Mom's C#: ( ) Dad's Name: Dad's C#: ( ) </p><p>Mom's Email: Dad's Email: </p><p>Are there any medical conditions to which we should be alerted? How did you hear about us? (if word of mouth, from whom?) </p><p>Has anyone in your family previousley been enrolled with us? Yes No If yes, approx. date/yr.</p><p>Payment/Class Information T/O Class Date Annual Family Administration Fee: $</p><p>Coach Day Tuition (per 4 week session. full payment required to reserve spot) $ Time Total Fees: (first session) $ $ T/O Class Date Total: $ Coach Day Time Program: Class: Day: Time: Program: Class: Day: Time: Program: Class: Day: Time:</p><p>Assumption of Risk * Waiver of Liability * Photo Release * Medical Authorization</p><p>I am aware there are inherent risks for potentiallysevere injuries including permanent paralysis or death when involved in sports or activities involving height and motion including but not limited to gymnastics, tumbling, trampoline, martial arts, dance, team, camps or any other activity at Flip 2 It Sports Center. Being fully aware of these dangers, I voluntarily consent on behalf of myself and my child(ren) to the participation in any and all Flip 2 It Sports Center programs, camps, classes and activities I ACCEPT ALL RISKS associated with the participation.</p><p>ON BEHALF OF MYSELF AND MY CHILD(REN), I ACCEPT ALL SUCH RISKS AND PROMISE NOT TO SUE, AND FOREVER RELEASE, JTS Sports Services, Inc. dba Flip 2 It Sports Center, each of their respective officers, directors, shareholders, employees,contractors, invitees, licensees and agents ("you") from all liability for damages or injuries incurred as a result of participation by my child(ren) or myself. This includes those injuries resulting from acts of negligence by you. I also waive all rights any third party may otherwise have to pursue a claim against you on my behalf (including the rights to subrogation). If, despite this agreement, I or any third party on my behalf makes a claim against you, I will defend, hold harmless and reimburse you for such claim and liabilities incurred as a result of such claim.</p><p>In the event of an accident or emergency I AUTHORIZE MY CHILD(REN) TO BE TRANSPORTED TO A MEDICAL FACILITY FOR TREATMENT, at my cost, and will hold you harmless in your managementof such accident or emergency. I agree to provide for all medical expenses which may be incurred by myself or my child(ren) as a result of any injury while on your premises or while under your care.</p><p>I am aware that photos and videos are taken from time to time for marketing and instructional purposes and I hereby consent to their use by you. I have read and understand this Assumption of Risk, Waiver of Liability, Photo Release and Medical Authorization. Parent/Legal Guardian Signature Date </p>