GYMNASTICS UNLIMITED, INC.

34016 9th Avenue South, Suite D-5, Federal Way, WA 98003

(253) 815-0998~GymUnlimitedOffice@gmail.com~www.GymnasticsUnlimitedUS.com

 United States Gymnastics Federation

MINOR CONSENT AND ASSUMPTION OF RISK STATEMENT

In CONSIDERATION of membership in the United States Gymnastics Federation, hereinafter referred to as the "USGF, USAG, USAIGC", and being allowed to participate in USGF, USAG,USAIGC events and/or member club activities, the parents(s) and/or legal guardian(s) of the minor participant named below agree:

1.        The parent(s) and/or legal guardians) to and will instruct the minor participating in any USGF, USAG, USAIGC and/or member club activity or event and regularly thereafter, that he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the instructor of such condition and refuse to participate.

2.        Participant shall be instructed to and shall carefully review and follow all USGF, USAG, USAIGC Gymnastics Safety Guidelines.

3.        I/We fully understand and will instruct the minor participating in gymnastic events and activities including:

a. There are risks and dangers associated with participation in gymnastics events and activities including but not limited to those of bodily injury, partial and/or total disability, paralysis and death.

b. The social and economic losses and/or damages, which could result from those risks and dangers described above, could be severe.

c. These risks and dangers may be caused by the negligence of the participant or the negligence of others.

d. There may be other risks not known to us or are not reasonably foreseeable at this time.

4.        I/we accept assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis, or death, however caused or alleged to be caused in whole or in part by the negligence of the USGF, USAG, USAIGC, its member clubs, event hosts, other participants, coaches, instructors, officials, sponsors, advertisers, owners and lessees of the premises used to conduct the event or activity and each of them, their officers, directors, agents and employees.

5.        I/we agree that this Consent and Assumption of Risk Statement covers each and every event or activity sponsored by the USGF, USAG, USAIGC and/or its member clubs.

6.        1 hereby grant permission for photographs and video clips of my child to be taken and used in news stories, advertisement, the website,  and gymnastics publications inside and outside of Gymnastics Unlimited, Inc.

I/WE HAVE READ THE ABOVE WAIVER AND SIGN IT VOLUNTARILY

_____________________________________________                   ______________________________________________
PRINTED NAME OF PARTICIPATING GYMNAST                SIGNATURE OF PARTICIPATING GYMNAST                        
_____________________________________________                 _____________________________________________        

PRINTED NAME OF PARENT/GUARDIAN                         SIGNATURE OF PARENT/GUARDIAN                                       

__________________________________________________________________                _______________________

WHAT SCHOOL DOES YOUR PARTICIPATING GYMNAST ATTEND?                         DATE                   

FRONT AND BACK MUST BE FILLED OUT

     

   

FIRST Name                                        MI               LAST Name                                            

Date of Birth
     

Health concerns (fainting, vision, asthma, diabetes, epilepsy, allergies, hearing, etc.)

Gender

Primary Care Physician’s Name

PCP’s Phone

Current Health Insurance Provider

FIRST Name                                        MI             LAST Name                                        

Gender

Date of Birth
           

FIRST Name                                        MI             LAST Name                                        

Gender

Date of Birth
           

FIRST Name                                        MI             LAST Name                                        

Gender

Date of Birth
           

Mother’s FIRST Name                                                                    MI                   LAST Name

Father’s FIRST Name                                                                     MI                   LAST Name

Mother’s Employer                                                        

Father’s Employer

Home Address

City                                                                                                                                      

State

Zip

Home Phone

Alternate Phone                              Contact Name

Cell Phone

Contact Name

Work Phone

Contact Name

Emergency Phone

Contact Name/Relation

E-mail Address(es)

How did you find us?             Instructor Recommendation                      Internet                      USA Gymnastics
Please circle one.                                 Member Recommendation                      Facebook                      Other _________________                                                        

By initialing to the left of each guideline below I indicate that I have read and understood the material:

______ Initial        1. There is an annual registration fee of $45.00 per family. WE PRORATE THIS FEE ONLY.

______ Initial        2. There are no refunds for any reason. However, make-ups will be allowed, if space is available within 30 days, except in the case of prolonged illness or injury. NO PRORATING TUITION.

______ Initial        3. Unless cancellation notice is given to the office, I will be billed for class each month.

______ Initial        4. Tuition is due the first class of each month. After the first class a $5.00 late fee will be assessed. Accounts including tuition, gym fees, and registration fees will not be carried past 30 days. If accounts remain unpaid, the child(ren) will not be allowed to participate.

______ Initial        5. All children in the viewing area must be closely supervised at all times and not left alone.  They may not use any of the equipment for play, gymnastics, etc.

______ Initial        6. No flash photography allowed.

______ Initial        7. Parents/Guardians are responsible for children before and after class. You must promptly pick up your child(ren) after class.