Please Print, Complete, & Return To AAGA
Last Name________________________________________________________
Address_________________________________________City______________
State ______________Zip____________
Parent’s Name________________________Home Phone___________________
Work Phone___________________
Parent’s Name________________________Home Phone___________________
Work Phone___________________
Cell Phone Numbers_________________________________________________
Pager_______________________
1st Child:
Name_______________________________Birthdate______________Age______
Class Level_____________________________________Male______Female_____
1st Choice - Day(s)___________________________Time_____________________
2nd Choice - Day(s)__________________________Time______________________
2nd Child:
Name_______________________________Birthdate______________Age______
Class Level_____________________________________Male______Female_____
1st Choice - Day(s)___________________________Time______________________
2nd Choice - Day(s)__________________________Time______________________
3rd Child:
Name_______________________________Birthdate______________Age______
Class Level_____________________________________Male______Female_____
1st Choice - Day(s)___________________________Time______________________
2nd Choice - Day(s)__________________________Time______________________
MEDICAL INFORMATION
Last Name_______________________
List any physical disabilities, chronic ailments,
psychological disabilities and allergies for each child:
1st Child Name
_____________________________________________________________________________________________________________________
2nd Child Name____________________________________________________
_________________________________________________________________
3rd Child Name____________________________________________________
_________________________________________________________________
Insurance Company Name_____________________
Policy Number ______________________________
Person to call in an emergency in the event the parents cannot be reached:
Name__________________________________Phone_____________________
I fully understand that there are risks of injury which are inherent in the sport of gymnastics. These risks include not only normal athletic strains and sprains, but also the possibility of sever injury from falls and accidents, even in the presence of due care. I, and my child, fully understand this.
I give my son/daughter_________________________
permission to participate at the All American Gymnastics Academy and authorize the All American Gymnastics Academy staff to act for me according to their best judgment in any emergency requiring medical attention. I hereby waive and release the All American Gymnastics Academy Inc., owners, managers, and coaches from any liability for an injuries while at the All American Gymnastics Academy or at any gymnastics meets, travel, or parents club sponsored activities. This form is valid for any time your child participates at All American Gymnastics Academy.
Parent/Guardian Signature:
_______________________________________________________________________
Date_______________________________________
Annual Fee $____________
($25.00 for 1st Child & $14.00 for each additional family member)
1st Child $_____________
2nd Child $_____________
3rd Child $_____________(15% discount)
Total $_____________