| GEORGIA ALL-STAR GYMNASTICS ENROLLMENT FORM |
| Parent's Name | Class | Day | Time |
| Address | City | State | Zip |
| Home Phone | Business Phone | Cell Phone | Emergency Contact & Phone |
| F M | |||
| Child's Name | Date of Birth | Age | Gender |
| email address | Health Insurance Company |
| Is your child currently on medication? | Yes/No | If so, what? |
| Previous Injuries: |
| Chronic Illness / Allergies: |
| How did you hear about Ga. All-Star Gymnastics? |
| I understand the withdrawal policy as published. |
| Parent Signature | Date |
| Please print this form and then FAX to 770-516-2653 |
| Waiver and Release |
| BECAUSE OF THE VERY NATURE OF THE SPORT OF GYMNASTICS, WHICH INVOLVES MOTION, HEIGHT AND SPEED, GYMNASTICS CARRIES WITH IT THE RISK OF PHYSICAL INJURY. THESE RISKS CAN BE REDUCED TO A SIGNIFICANT DEGREE. THEY CANNOT BE ELIMINATED. |
|
I authorize the staff of Georgia All-Star Gymnastics, Inc. to organize and required medical treatment or first aid procedure
in the event that such a situation arises, and the parent, guardian or emergency contact person is not available. The undersigned hereby forever releases, discharges and covenants to hold harmless the staff of Georgia All-Star Gymnastics, Inc. and any other person, firm or corporation charged or chargeable with responsibility or liability, their heirs, administrators, executors, successors, and assignees from any and all claims, demands, damages, costs, expenses, loss of service, actions and causes of action belonging to the undersigned or arising out of any act or occurence and particularly on account of all personal injury, disability, property damage, loss or damage of any kind sustained or that may hereafter be sustained arising out of the matters described herein or in consequence of participation in the above mentioned program. The undersigned hereby bind their heirs, administrators, executors and successors. |
| Date: | Signed: |
| Relationship to Participant: |
| - Please print this form and then FAX to 770-516-2653 - |
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THIS IS A 10-MONTH PROGRAM. IF YOU NEED TO WITHDRAW YOUR CHILD FROM CLASS THE FRONT OFFICE MUST HAVE WRITTEN NOTICE BEFORE THE 7TH WEEK OF THAT 9-WEEK PAYMENT PERIOD. NO OTHER WITHDRAWAL TIME WILL BE ACCEPTED, AND YOU WILL CONTINUE TO BE FINANCIALLY RESPONSIBLE FOR PAYMENT. 2ND SESSION NOTICE HAS TO BE GIVEN BEFORE October 5th, 2007 3RD SESSION NOTICE HAS TO BE GIVEN BEFORE DECEMBER 7TH, 2007 4TH SESSION NOTICE HAS TO BE GIVEN BEFORE FEBRUARY 22TH, 2008 |