Foothills Gymnastics and Cheer Center Registration Form

Foothills Gymnastics and Cheer Center Registration Form
Participant's Full Name*

First NameLast Name
Participant's Date of Birth*

MonthDayYear
Date
Parent/Guardian's Full Name*

First NameLast Name
Parent/Guardian's Phone Number*
Please enter a valid phone number.
Parent/Guardian's Email Address*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.

Please list any previous illness or injury we should be aware of. Any allergies to medication.
Primary medical insurance policy name and number*
Previous Gymnastics, Tumbling, Cheer, Dance, and Ninja Experience (Describe Briefly)
Read the following carefully and sign below. Club Waiver and Release Form Agreement In consideration of my membership in Foothills Gymnastics Center, Inc. and my participation in Foothills Gymnastics Center, Inc. classes, events, and activities, I agree to be bound by each of the following:

1. Eligibility: I agree to comply with the rules of Foothills Gymnastics Center, Inc.

2. Readiness to Participate: I will only participate in those Foothills Gymnastics Center, Inc. classes, events, competitions and activities for which I believe I am physically and psychologically prepared. Prior to participation, I will have practiced my exercises and will perform only those exercises which I have accomplished to the degree of confidence necessary to assure I can perform them by myself, and without injury.

3. Medical Attention: I hereby give my consent to Foothills Gymnastics Center, Inc. to provide through a medical staff of its choice, customary medical/athletic training attention, transportation, and emergency medical services as warranted in the course of my participation.

4. I hereby acknowledge the Covid-19, Coronavirus, SARS-CoV-2 pandemic, and any mutation thereof. I understand that the virus is contagious and that the individuals carrying the virus may exhibit no symptoms, making detection of carriers impossible. I accept my responsibility to guard against the spread of Covid-19 at the facility. I waive, covenant not to sue and forever release, Foothills Gymnastics Center, Inc. from all liability as a result of contracting Covid-19. I warrant that if my child will meet any of the listed factors (shortness of breath, cough, fever ) we will notify Foothills and not visit the facility.

5. Waiver and Release: We, the staff of Foothills Gymnastics Center, Inc. recognize our obligation to make our students and their parents aware of the risks and hazards associated with the sport of gymnastics, tumbling, cheerleading, aerobics and dance. Students may suffer injuries, possibly minor, serious, or catastrophic in nature. Gymnastics, Ninja, Tumbling and Cheerleading can be dangerous and can lead to injury.

I further agree that Foothills Gymnastics Center, Inc. and the sponsor of any Foothills Gymnastics Center, Inc. event, along with the employees, agents, officer’s, and directors of these organizations shall not be liable for any losses or damages occurring as a result of my participation in the event, except where such loss or damage is the result of the intentional or reckless conduct of one of the organizations or individuals identified above.

Primary Medical Insurance: I am covered by a primary health/medical/accident insurance through:

Policy name/ #_____________________________
For any athlete who is not yet 18 years old: As legal parent or guardian of this athlete, I hereby verify by my signature below that I fully understand and accept each of the above conditions for permitting my child toparticipate in classes, events, competitions, and activities conducted by Foothills Gymnastics Center, Inc.*

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Yearly Membership Fee

$20.00 Quantity

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$0.00

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