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: firstname.lastname@example.org
Name: _____________________________________ Age (on 10/11/11): ____________
Date of Birth: _____________________________________ Gender: _____________________
Phone number: ___________________________ Email: __________________________
Events competing (can change later):________________________________________________
In Case of Emergency, please contact:
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.
Please email this form to Marina at email@example.com, 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 firstname.lastname@example.org. Thank you for your interest!