Grand Rapids Gymnastics Academy Registration Form
Student's Name_____________________________Birthdate__________
Address____________________________________________________
City/State/Zip_______________________________________________
Phone____________ School_____________
Parent/Guardian Name(s) ______________________________________
Parent/Guardian Home Phone___________________________________
Parent/Guardian Work Phone___________________________________
Parent/Guardian Mobile Phone__________________________________
Parent/Guardian Email Address_________________________________
Emergency Contact Name______________________________________
Emergency Contact Phone______________________________________
Registration Fee
Grand Rapids Gymnastics Academy charges a one-time registration fee of $25 per family. Each following year, GRGA charges a $25 renewal fee per family. We ask that you include your $25 registration fee with this form when registering. These fees assist in offsetting the cost of insurance paid per student.
For a complete set of GRGA payment and gym policies, please visit www.grgymacademy.com
Grand Rapids Gymnastics AcademySpecial Events WaiverYour child will be using gymnastics equipment at Grand Rapids Gymnastics Academy. Because there is risk involved, you must fill out and sign this form or your child will not be permitted to participate.
Child's Name_____________________________________
Parent/Guardian Name_____________________________
Liability WaiverBy signing below, you agree that you are aware that your child named above will be engaging in physical exercise involving sports, coordination and fitness training, which could cause injury to them. You further agree that your child is voluntarily participating in these activities and as a parent/guardian; you are assuming all knowledge of the injuries which may result from your child's participation. You hereby accept these risks and agree to waive any claims or rights that you may otherwise have to bring action or suit upon employees or owners for injuries that may occur as a result of these activities.
Parent/Guardian Signature___________________________Date _________________
Grand Rapids Gymnastics Academy Emergency Information
Known Medical Conditions/Problems (Check all that apply)
__ Nothing Known__ Asthma__ Hearing Problems__ Muscle Weakness__ Epilepsy__ Cardiac/Heart __ Diabetic__ Hemophilic__ Headache__ Special blood problems__ Wears glasses__ Wears contacts__ Nose bleeds__ Allergies (please list) _____________________________
__ Takes medications regularly (please indicate how often)___________________ _______________________________________________________________
Does your child have any physical restrictions (if yes, what)?
Are there are any special parental arrangements we should be aware of?_______________________________________________________________________
Other Adults we can Contact in Case of an Emergency:
Name _______________________________ Telephone _________________________
Name _______________________________ Telephone _________________________
Name _______________________________ Telephone _________________________
In an emergency, this information on this sheet could be imperative to the welfare of your child. Please notify the Grand Rapids Gymnastics Academy of any changes that may occur during the time your child attends the academy.
Consent to Treat
I understand that my child may be injured while participating in gymnastics at the Grand Rapids Gymnastics Academy.
I authorize the Grand Rapids Gymnastics Academy to obtain emergency care that may be necessary while participating in the Grand Rapids Gymnastics Academy's programs.
Parent/Guardian Signature_______________________________Date_______________
Assumption of Risk
I understand that while my child is participating in gymnastics, there is a risk of injury. I understand that such an injury can range from a minor injury to a major injury.
I hereby accept and assume the risk of injury to my child and understand the possible consequences of such injury.
Parent/Guardian Signature_______________________________Date_______________
Student's Name_____________________________Birthdate__________
Address____________________________________________________
City/State/Zip_______________________________________________
Phone____________ School_____________
Parent/Guardian Name(s) ______________________________________
Parent/Guardian Home Phone___________________________________
Parent/Guardian Work Phone___________________________________
Parent/Guardian Mobile Phone__________________________________
Parent/Guardian Email Address_________________________________
Emergency Contact Name______________________________________
Emergency Contact Phone______________________________________
Registration Fee
Grand Rapids Gymnastics Academy charges a one-time registration fee of $25 per family. Each following year, GRGA charges a $25 renewal fee per family. We ask that you include your $25 registration fee with this form when registering. These fees assist in offsetting the cost of insurance paid per student.
For a complete set of GRGA payment and gym policies, please visit www.grgymacademy.com
Grand Rapids Gymnastics AcademySpecial Events WaiverYour child will be using gymnastics equipment at Grand Rapids Gymnastics Academy. Because there is risk involved, you must fill out and sign this form or your child will not be permitted to participate.
Child's Name_____________________________________
Parent/Guardian Name_____________________________
Liability WaiverBy signing below, you agree that you are aware that your child named above will be engaging in physical exercise involving sports, coordination and fitness training, which could cause injury to them. You further agree that your child is voluntarily participating in these activities and as a parent/guardian; you are assuming all knowledge of the injuries which may result from your child's participation. You hereby accept these risks and agree to waive any claims or rights that you may otherwise have to bring action or suit upon employees or owners for injuries that may occur as a result of these activities.
Parent/Guardian Signature___________________________Date _________________
Grand Rapids Gymnastics Academy Emergency Information
Known Medical Conditions/Problems (Check all that apply)
__ Nothing Known__ Asthma__ Hearing Problems__ Muscle Weakness__ Epilepsy__ Cardiac/Heart __ Diabetic__ Hemophilic__ Headache__ Special blood problems__ Wears glasses__ Wears contacts__ Nose bleeds__ Allergies (please list) _____________________________
__ Takes medications regularly (please indicate how often)___________________ _______________________________________________________________
Does your child have any physical restrictions (if yes, what)?
Are there are any special parental arrangements we should be aware of?_______________________________________________________________________
Other Adults we can Contact in Case of an Emergency:
Name _______________________________ Telephone _________________________
Name _______________________________ Telephone _________________________
Name _______________________________ Telephone _________________________
In an emergency, this information on this sheet could be imperative to the welfare of your child. Please notify the Grand Rapids Gymnastics Academy of any changes that may occur during the time your child attends the academy.
Consent to Treat
I understand that my child may be injured while participating in gymnastics at the Grand Rapids Gymnastics Academy.
I authorize the Grand Rapids Gymnastics Academy to obtain emergency care that may be necessary while participating in the Grand Rapids Gymnastics Academy's programs.
Parent/Guardian Signature_______________________________Date_______________
Assumption of Risk
I understand that while my child is participating in gymnastics, there is a risk of injury. I understand that such an injury can range from a minor injury to a major injury.
I hereby accept and assume the risk of injury to my child and understand the possible consequences of such injury.
Parent/Guardian Signature_______________________________Date_______________