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FALL REGISTRATION FORM

 

 

FALL SEASON 2018 REGISTRATION / WAIVER FORM

Fall classes began Tuesday, September 4th, 2018

new members can join anytime.

**For new members - your first months payment and registration fee should

accompany this registration form.

**For existing members - you will need to resign your existing waiver form, your

first months payment and registration fee will secure your class spot.

Please make checks payable to: Harrisburg Gymnastics School or H.G.S.

(checks should include child’s name, class day and time).

ALL CLASSES ARE FILLED ON A FIRST COME FIRST SERVE BASIS, REGISTER EARLY.

Office Use: Cash/check # or c.card______________$______________Confirmed______________

REGISTRATION / WAIVER FORM


GYMNAST NAME_________________________________________________BIRTH DATE____________________

STREET_____________________________________________________________________________________

CITY___________________________________________________________ZIP_________________________

HOME PHONE#________________________________CELL/EMERGENCY#________________________________

E-MAIL ADDRESS______________________________________________________________________________

 

CHOOSE CLASS DAY AND TIME________________________________________________________

 

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_________________

 

NO REFUND AFTER LABOR DAY.

 

 

 

 

Last Updated (Wednesday, 17 January 2018 16:56)