Registration and Health Form
Gymnast's Name: _____________________________Age: ____ Birthday:___________
Mother's Name: ______________________________Work Phone: _________________
Father's Name: ______________________________ Work Phone: ________________
Home Phone: _________________ Class Level: ______ Day: _______ Time: ______ Mailing Address: _________________________________________________________
***(street) ***(city) ***(zip code)
Please check if your child has ever had any of the following:
Allergies ____ Asthma ____ Arthritis ____ Heart Ailment ____ Broken Bones ____
If you check any please explain: ___________________________________________
Please list any medications your child is currently taking: _____________________
Any other health information we should be aware of: _________________________ ________________________________________________________________________
________________________________________________________________________
RELEASE FOR TREATMENT: Although all precautions are taken to prevent accidents, they cannot be ruled out. Simple first aid will be administered to all minor injuries and parents will be called when necessary. I confirm that my child is in good health. I hereby authorize and consent to any x-ray, exam, anesthetic, medical or surgical diagnosis to treatment deemed necessary by the medical center or immediate care facilities.
Parent's Signature: ___________________________________ Date: _______________
NOTIFICATION OF RISK: Gymnastics coaching is a serious business conducted by professionals. We are competent, trained specialists. We routinely do daily safety checks of the equipment. Gymnastics like any other athletic activity involving bodily motions involves the risk of injury. You as parents or guardians must be aware of these risks. I am aware of the risks of injury involved in participation in gymnastics.
Parent's Signature: ___________________________________ Date: _______________