Tri-County Gymnastics & Cheer Medical Waiver & Release
Please make sure you fill this out if you would like your child to participate in our Open Gyms at Tri-County.
Today's Date *
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Child's First Name *
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Child's Last Name *
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Child's Date of Birth *
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Child's Gender *
Parent's First Name *
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Parent's Last Name *
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Street Address *
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City *
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State *
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Zip Code *
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Home Phone Number
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Cell Phone Number *
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Email Address *
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Emergency Contact Person *
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Relation to Child *
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Emergency Contact Phone Number *
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Medical Insurance Company *
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Preferred Hospital *
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Hospital Address *
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Doctor's Name *
Your answer
Please answer the following questions about your child. If the answer is "YES" to any of these please briefly describe below on the next question. *
Yes
No
Previous Gymnastics experience?
Previous Cheerleading experience?
Allergies or intolerance to food or medications?
Medications currently being taken?
Previous injuries or illnesses?
Restrictions or special considerations?
Permission for certain medications (ibuprofen, cough drops,, cough medicine)?
If yes to any of the questions above, please briefly explain here
Your answer
Athletic Waiver & Release
I fully understand that Tri-County Gymnastics & Cheer, LLCstaff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the Tri-County Gymnastics & Cheer, LLC staff to render first aid to my child in the event of any injury or illness, and if deemed necessary by the Tri-County Gymnastics & Cheer, LLC staff to call our doctor and to seek medical help, including transportation by a Tri-County Gymnastics & Cheer, LLC staff member or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the Tri-County Gymnastics & Cheer, LLC staff deem this to be necessary.
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By entering your name below you're agreeing to the terms in the Athletic Waiver & Release *
Your answer
Athletic Waiver & Release Part 2
The staff of Tri-County Gymnastics & Cheer, LLC recognizes its obligation to make students and their parents aware of the risks and hazards associated with the sport of gymnastics, trampoline, tumbling, cheerleading, dance, warrior ninja and camps. Gymnastics, trampoline, tumbling, cheerleading, dance and camps can be dangerous and can lead to injury. Students may suffer injuries, possibly minor, serious, or catastrophic in nature. Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and the coaches’ instructions. Tri-County Gymnastics & Cheer, LLC, its coaches, and other staff members will not accept responsibility for injuries sustained by any student during the course of gymnastics, trampoline, tumbling, cheerleading, dance,warrior ninja and camp instruction, or open workouts or in the case of any exhibition, competition, or clinic in which he or she may participate while traveling to or from the event. With the above in mind, and being fully aware of the risks and possibility on injury involved, I consent to have my child or children participate in the programs offered by Tri-County Gymnastics & Cheer, LLC. I, my executors, or other representatives, waive and release all rights and claims for damages that I or my child may have against Tri-County Gymnastics & Cheer, LLC and/or its representatives whether paid or volunteer. I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage which I consider adequate for both my child’s protection and my own protection. I also understand that it is the parents’ responsibility to warn the child about the dangers of gymnastics, cheerleading,and injury. The parent should warn the child according to what the parent feels is appropriate. Tri-County Gymnastics & Cheer, LLC will only warn the child through “safety messages” and our teaching style and progressions.
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By entering your name below you're agreeing to the terms in the Athletic Waiver & Release Part 2 *
Your answer
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