American Gymnastics and Cheer Registration Form
CLASS INFORMATION
Class		Group	Day		Time
Gymnastics
Trampoline
Tumbling
Cheer
STUDENT INFORMATION
Child’s Name:
Date of Birth:				Age:
Address:
City:			State:	Zip:
Medical Conditions, Allergies, or any other medical information:
Any special information or comments you would like us to know about the above member:
PARENT INFORMATION
Mother’s Name:			Mother’s E-Mail Address:
Phone Numbers:	Home:		Work:		Cell:
Father’s Name:			Father’s E-Mail Address:
Phone Numbers:	Home:		Work:		Cell:
IN EVENT OF EMERGENCY
Emergency Contact (other than parents):
Relationship:			Phone:
RELEASE (must be signed and dated)
I release American Gymnastics, its director, and staff from any and all responsibility due to accident or injury sustained during participation in activities. I am aware that in gymnastics, as in any sport involving height and motion, the possibility of serious injury and/or paralysis or even death is present. The child named above has my full consent to participate in the American gymnastics programs. Parent/Guardian: __________________________________________ Date________________________ In the event of an emergency, and parents cannot be contacted, I/we give American Gymnastics, it’s coaches, and/or staff , permission to administer/obtain and sign for medical treatment. Parent/Guardian: __________________________________________ Date________________________