Get Adobe Flash player

Summer Registration Form

 

 

SUMMER 2018 REGISTRATION / WAIVER FORM

SUMMER CLASSES BEGaN JULY 9TH, 2018

**Your first months payment, registration fee (for new members)

SHOULD ACCOMPANY  THIS REGISTRATION / waiver form.

PLEASE MAKE CHECKS PAYABLE TO:  hARRISBURG GYMNASTICS SCHOOL OR  H.G.S.

(check memo should include child's name, class day and class time).

OFFICE USE: Check#/Cash____________$______________Confirmed_____________

HARRISBURG GYMNASTICS SCHOOL, INC.

3427 DERRY STREET

HARRISBURG, PA 17111

(717)561-0959

REGISTRATION / WAIVER FORM

GYMNAST NAME_____________________________________________BIRTH DATE__________________________

STREET_______________________________________________________________________________________

CITY_______________________________________________________________ZIP_________________________

HOME/CELL PHONE#____________________________________EMERGENCY#_______________________________

E-MAIL ADDRESS_________________________________________________________________________________

 

FIRST CLASS CHOICE_____________________________________________________________

SECOND CLASS CHOICE___________________________________________________________

Has your child had gymnastics classes before?___________________________________________

If "no", how did you hear about our program?___________________________________________

 

MEDICAL BACKGROUND

Please describe below any physical or psychological factors which may affect your child's participation in gymnastics.

Instructors need to be aware of these conditions in order to provide a safe and positive atmosphere for your child.

Physical conditions such as asthma, vision or inner ear problems, epilepsy, recent surgery . pre-existing injuries, etc.

______________________________________________________________________________________

Psychological conditions such as adhd, fears, anxieties, autism, etc.

______________________________________________________________________________________

SAFETY WARNING

By the very nature of the activity, gymnastics carries a risk of physical injury.

No matter how careful the gymnast and coach are, no matter how many spotters are used, no matter what heights are used or what landing surface exists,

the risks cannot be eliminated. The risk of injury includes minor injuries such as bruised and more serious injuries such as broken bones,

dislocations and muscle pulls. The risk also includes catastrophic injuries such as permanent paralysis or even death from landings or falls on the back, neck or head.

SIGNATURE____________________________________________________

LIABILITY FORM FOR H.G.S. INC.

Please enter the above person for participation in a program offered by the Harrisburg Gymnastics School, Inc. On consideration of this entry,

the participant, his heirs and assignees, waive any and all claims in which he or she may have against the Harrisburg Gymnastics School, Inc.

and any or all claims due to injuries sustained by the participation in all activities sponsored by the Harrisburg Gymnastics School, Inc.

or from pre-existing injuries or conditions which may have occurred prior to gymnastics participation.

Let it be known that the participant_________________________is fully covered by accident insurance through their personal insurance policy.

 

Medical Insurance Company name

____________________________________________________________________________________

Signature of Parent/Guardian

_____________________________________________________________________________________

date_________________________________________________________________________________

 

ALL CLASSES AND CAMPS ARE COED.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Updated (Monday, 17 September 2018 23:28)