FIRST FLIPS GYMNASTICS 2007 - 2008

4945 POINTE PARKWAY WARRENSVILLE HTS., OHIO 44128  

PHONE: 216 - 595 - 1859  FAX: 216 -  595 - 1866

 

$40 Registration Fee per family is due annually based on your registration date

THERE ARE ABSOLUTELY NO REFUNDS OF CLASS OR REGISTRATION FEES.

 

STUDENT'S NAME:__________________________________   AGE:____  BIRTH DATE:______________________

CLASS CHOICE: ___________________________  

 

STUDENT'S NAME:__________________________________   AGE:____  BIRTH DATE:______________________

CLASS CHOICE: ___________________________

 

MOTHER'S NAME:____________________________________   E-MAIL:____________________________________

FATHER'S NAME:_____________________________________  E-MAIL:____________________________________

ADDRESS:_____________________________________  CITY_____________________________  ZIP_____________

HOME PHONE:____________________________   WORK or EMERGENCY PHONE:__________________________

HOW DID YOU HEAR ABOUT US?             __ SIGN / WALK-IN __ NEWSPAPER __ YELLOW PAGES  

__ INTERNET   __ REFERRAL - NAME ________________________

 

PRE-PARTICIPATION

Please use this for ALL children enrolled

 

Child’s Name (s) _________________________________________________     Date of last physical ____________

 

Family Physician’s Name _____________________________________ Physician’s phone: _______________________

 

Please fill out this section BEFORE participation in any class activities. Explain “Yes” answers below.

Do you have, or have had any medical conditions that would limit your ability to participate in any activities while at TEGA? Y               N

Are you currently taking any prescription or nonprescription medications or use an inhaler?               Y              N

Do you have any allergies?                 Y              N

Explain “Yes” answers or provide pertinent medical info here: ___________________________________________________________________________________________________

 

___________________________________________________________________________________________________

 

Parent / Guardian signature _________________________________________________   Date: _________________

 

PARTICIPATION RELEASE

I/We, hereby give permission for my/our child (ren) to fully participate in First Flips Gymnastics’ program. I understand that, as with any sport, there are certain inherent risks in gymnastics and related activities and that I, intending to be legally bound, waive and release The Elite Gymnastics Academy, Inc., its employees and officers, of all responsibility for any injury sustained by my child in connection with the program at The Elite Gymnastics Academy, Inc. or its facilities. This agreement extends to my heirs or executors who may not act in my behalf. Furthermore, I/We give permission to transport my/our child (ren) to a nearby medical facility if reasonable efforts to contact us have failed. I/We also understand that credit will be given for medical reasons only, which must be verified by a Doctor's certificate.

 

Parent / Guardian signature _________________________________________________   Date: _________________

 

ADULT PARTICIPATION RELEASE

Please sign below if participating in “Mommy & Me” or “Family Fitness” class

 

I, the undersigned, understand that by participating fully in First Flips Gymnastics’ program, as with any sport, there are certain inherent risks in gymnastics and related activities. I, intending to be legally bound, waive and release The Elite Gymnastics Academy, Inc., it’s employees and officers, of all responsibility for any injury sustained by me in connection with the program at The Elite Gymnastics Academy, Inc., or it’s facilities. This agreement extends to my heirs, or executors who may act in my behalf.

 

Signature: ______________________________________________________________    Date: _________________