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Child's Name ( Last, First )

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Age

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Birth Date

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Address ( Street, City, Zip )

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Phone Number

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Mother's Name

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Daytime Phone Number

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Father's Name

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Daytime Phone Number

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Emergency Contact

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Daytime Phone Number

It is understood that gymnastics is a high-risk sport and could result in injury. A gymnast, in attending the gym and using the facilities, does so at his or her own risk. The gym operator shall not be liable for any damage arising from personal injuries sustained by the gymnast in or about the premises. The gymnast assumes full responsibility for all injuries and damages which may occur in or about the premises and he or she does hereby fully and forever release and discharge the gym opertor, all associated gyms, their owners, employees and agents from any and all claims, demands, damages, and rights of action, present or future, resulting from or arising out of the gymnast's use of the gym and or its facilities without cause.

South Bay Gymnastics Camp activities may include but are not limited to gymnastics, dance, trampoline, arts and crafts, and park trips within walking distance from the gym. Posted signs on the front doo will indicate the location of the children if they are not within the facility.

I / We testift that I / We have read the above completely and understand the aforementioned, and agree to its principle completely without hesitation.

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Gymnast's Name:

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Parent / Gaurdian Signature:

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Witness for South Bay Gymnatics:

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Date Signed: