Registration Form 2024/25

Athlete Information

Athlete's Name

First NameLast Name

Class

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

2nd Athlete's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Parent/Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number

Area CodePhone Number

Cell Number*

Area CodePhone Number

E-mail*

Father/Guardian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

Email

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Is the athlete prescribed an inhaler? If yes, please explain any instructions.*

Insurance Information

Name of Policy Holder*

Insurance Company*

Policy Number

GULF COAST RHYTHMICS L.L.C.
WAIVER OF LIABILITY AND PARENT/GUARDIAN PERMISSION FORM

STUDENT NAME: {1stAthletes} (the “Student”)
In order to receive instruction in a Gulf Coast Rhythmics L.L.C. rhythmic gymnastics instruction or coaching program (the “Program”), each student needs to complete the Waiver of Liability and Parental Permission form. Student will not be permitted to participate in the Program until Student or Student’s parent or guardian has submitted a completed form and, upon the request of Gulf Coast Rhythmics, L.L.C., or its designee, has executed a Payment Agreement.
agreement to participate
To ensure that you and, if you are under the age of 18, your parent(s) understand and accept the risks of participation in the Program, you both must indicate your understanding and agreement by signing on the appropriate lines below.
STUDENT agreement
I affirm that my participation in the Program is entirely voluntary, and understand that participation in the Program involves a risk of injury due to certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries, such as, but not limited to, the following: contact with other students participating in the Program (including routines, performance, and exercises); contact with the floor, walls, or equipment which are used in the Program; and strenuous exertions, which place stress on the cardiovascular, muscular and skeletal systems. The specific risks vary from (1) minor injuries such as scratches, bruises and sprains, to (2) major injuries such as, joint or back injuries, heart attacks, and concussions, to (3) catastrophic injuries including paralysis and death. I understand that if I have questions about possible hazards, it is my responsibility to seek additional information from the Program staff prior to signing this Form. I also understand that, despite safety precautions, the Program instructors, administrators, owners and operators cannot guarantee that I will not be injured. I agree to assume these risks.
I understand that the best way to make sure that I remain safe and avoid injury is to follow the rules, regulations and instructions of the Program’s staff. I agree that I will learn and obey all the rules and regulations and will follow all instructions, directions and requests of the Program’s staff.
parent/guardian agreement
I agree to allow my child/ward to participate in the Program and affirm that my child’s/ward’s participation is completely voluntary. I understand that there are risks inherent in the activities my child will engage in at the Program (some of which are described above), which may cause serious injury or even death. I also understand that, despite safety precautions, the Program instructors, administrators, owners and operators cannot guarantee that my child/ward will not be injured. My child/ward and I are willing to assume these risks. To minimize the risk, I have instructed my child/ward to obey all the rules, regulations, instructions, directions and requests of the Program. I agree that the term “Student”, as used herein, also refers to myself as the parent/guardian of my child/ward.
assumption of risk, waiver of liability, release & agreement to sue:
In consideration for permitting me/my child/ward to participate in the Program, I voluntarily agree, for myself, my heirs, personal representatives, successors and assigns to the following:
to assume full responsibility for any risks or loss, or personal injury, including death that may be sustained by me/my child/ward, or any loss or damage to property owned by me/my child/ward, as a result of training for, participating in, or traveling to or from the Program or any Program related activity.
1. TO RELEASE, WAIVE, HOLD HARMLESS, DISCHARGE, AND AGREE NOT TO SUE Gulf Coast Rhythmics L.L.C., or its members, officers, employees, agents, students, and staff from any and all liability, claims, actions, demands, expenses, attorney fees, breach of contract actions, breach of statutory duty, or other duty of care, warranty, strict or other liability actions, and causes of action whatsoever, that I might now have or may acquire in the future, arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while training for, traveling to or from, or participating in the Program or any Program related activities.
2. The STUDENT is MENTALLY AND Physically Sound. The undersigned represents that the Student is mentally and physically sound and suffering from no condition or impairment that would prevent the Student’s safe participation in the instruction and physical activities offered by the Program and all Program activities. The undersigned agrees to keep the Student’s instructor and all other Program personnel informed of changes to the Student’s physical condition or changes in the Student’s ability to perform the activities associated with the Student’s training, the instruction and the Program activities. The undersigned represents that the undersigned has disclosed and will continue to disclose all physical or mental conditions, diseases, impairments, complaints, disorders, and infirmities that may, in any way, shape, or form, affect the Student’s ability to participate safely in the instruction and physical activities offered by the Program and all Program activities.

3. The STUDENT Has Had a Recent Physical Examination. The undersigned acknowledges that it is recommended that the Student has a yearly or more frequent physical examination and consultation with the Student’s physician regarding physical activity, exercise and use of exercise equipment. The Student has either (i) had a physical examination and been given the Student’s physician’s permission to participate in the instruction and Program activities or (ii) the undersigned allows the Student to participate in the Program activities without the approval of the Student’s physician and assume(s) responsibility for that participation.
PHOTO RELEASE: I give permission for photographs taken of me/my child/ward while participating in the Program and Program activities to be used in marketing and public relations material in the promotion of the Program.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Gulf Coast Rhythmics LLC has put in place preventative measures to reduce the spread of COVID-19; however, GCR cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending GCR could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending activities at Gulf Coast Rhythmics and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at GCR may result from the actions, omissions, or negligence of myself and others, including, but not limited to, GRC employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at GCR or participation in GCR programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Gulf Coast Rhythmics LLC, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of GCR, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Gulf Coast Rhythmics LLC during any and all activites. In exchange for the acceptance of said child’s candidacy by Gulf Coast Rhythmics LLC, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Gulf Coast Rhythmics LLC and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Gulf Coast Rhythmics LLC including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Gulf Coast Rhythmics LLC and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

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Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

PAYMENT POLICY:

All monthly tuition will be executed via Auto-pay.
Tuition payment comes out the first (1st) of every month. Payment in full at the time of enrollment includes 2 months tuition, plus Regstration fee of $35. We do not pro-rate currently enrolled students.
A $20.00 fee will be added to returned checks.
A $15.00 late fee will be added for accounts past due greater than 5 calender days.
We reserve the right to refuse service for unpaid accounts.
You are enrolled from your starting date until May 30, 2024. You are responsible to pay for all programs in which you have enrolled. Written notice must be given 30 days prior to withdrawal from the program which you have enrolled.
Once funds are put into the system, GCR will credit 100% of any unused funds towards any other program or the store for up to six (6) months. No cash refunds will be given.
Registration and Deposit fees are non-refundable.
All discounts are lost when accounts go into past due status.

2022/23 Season