Adult Gymnastics Meet Entry Form

Date:  Saturday, October 1, 2011                                   Time:  Warm-up – 6:00pm/Meet – 7:30pm

Location:  Capital Gymnastics NTC                           Entry Fee:  $40

                10400 Premier Court                                    Entry Deadline:  Wednesday, Sept. 21, 2011                    Burke, VA  22015                                       Contact:  marina@gymnastike.org

            703-239-0044/46                   

Name:                  _____________________________________ Age (on 10/11/11):  ____________

Date of Birth: _____________________________________   Gender: _____________________

Address:                          ____________________________________________________________

Phone number:                ___________________________ Email: __________________________

Events competing (can change later):________________________________________________

In Case of Emergency, please contact:

                Name:  ________________________________________Relationship:_______________

                Phone:__________________________________________________________________

Release:               

I agree to participate in the programs held by Capital Gymnastics LLC.  I am aware and understand the risks involved in gymnastics, and I release Capital Gymnastics National Training Center, its employees, and all those affiliated with the Adult Gymnastics Meet taking place on October 1, 2011, from any and all liability that might be incurred during the conduct of this activity.  I further agree to indemnify and hold the Capital Gymnastics LLC harmless for any claims or lawsuits brought by me or on my behalf.

In an emergency, I grant permission to Capital Gymnastics LLC and its employees, at my expense, to use the most convenient volunteer rescue squad vehicle or ambulance to transport me to the hospital, and if necessary, I authorize medical treatment.  I hereby verify that I am healthy and capable of participating in the sport of gymnastics.

Print name:

______________________________________________________

Signed:

________________________________________________Date:_________________________

 

Please email this form to Marina at marina@gymnastike.org, and please send a paper copy, along with your $40 entry fee, by September 21, 2011, to:

Capital Gymnastics National Training Center

c/o Adult Gymnastics

10400 Premier Court

Burke, VA 22015

Questions?  Contact Marina Mazor at marina@gymnastike.org.  Thank you for your interest!