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Lakes Gymnastics Summer Programs!! (THIS IS NOT THE FORM FOR SUMMER CAMP REGISTRATION!!)Summer Classes Registration Form
(Please make copies for multiple children)
ChildŐs Name:___________________________________
Age:______ Sex:______ Birth Date:_______________
ParentsŐ Names: _______________________________________________________________________________
ParentsŐ Address:__________________________________ City:________________
State:_____ Zip:_________
Home Phone:___________________
MomŐs Work #:___________________
DadŐs Work #:_________________
Emergency Name &
#, in case parents cannot be reached:_______________________________________________
Allergies/Medical Concerns:______________________________________________________________________
Please Put a Check Next to the Weeks for Which You Are Registering:
Week # 1_____ Week # 2_____ Week # 3_____ Week # 4_____ Week # 5_____
Week # 6_____ Week # 7_____ Week # 8_____ Week # 9_____
Please Put a Check Next to the Program for Which You Are Registering:
Parent & Tots_____
Super Stars_____
Shooting Stars_____
Super Stars Advanced_____
Rising Stars_____
Girls Extreme Stars_____
á I fully understand that FLGA staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the FLGA staff to render temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the FLGA staff to call our doctor and to seek medical help, including transportation by a FLGA staff member and/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 FLGA staff deem this to be necessary. We, the staff of FLGA recognize our obligation to make our students and their parents aware of the risks and hazards associated with the sports of gymnastics, tumbling and cheerleading. Students may suffer injuries, possibly minor, serious or catastrophic in nature. Gymnastics, Tumbling and Cheerleading can be dangerous and lead to injury! Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and the coachesŐ instructions. FLGA, its coaches and other staff members, will not accept responsibility for injuries sustained by any student during the course of gymnastics, tumbling, or cheerleading instruction, or open workouts, or in the course 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 of injury involved, I consent to have my child or children participate in the programs offered by FLGA. I, my executors or other representatives, waive and release all rights and claims for damages that my child or I may have against FLGA 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 childŐs protection and my own protection. I also understand that it is the parentsŐ responsibility to warn the child about the dangers of gymnastics and injury. The parent should warn the child according to what the parent feels is appropriate. FLGA will only warn the child through Ňsafety messagesÓ and our teaching style and progressions.
ParentŐs Signature:_____________________________________________________ Date:___________________ ParentŐs Signature:_____________________________________________________ Date:___________________
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