Gymnastics Camp Registration Form

Gymnastics Camp Registration Form
Venue: 227 Lowes Alley, Statesville, NC, 28625
Date: January 7, 2019
Time: 9:00 AM
Camper Information
Name
First NameLast Name
Phone Number
Area CodePhone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Date of Birth
MonthDayYear
Date
Age
Height
Weight
Parent or Guardian Information
Parent or Guardian
First NameLast Name
Phone Number
Area CodePhone Number
Medical and Insurance Information
Allergies
Current Medications
Previous Injuries
Health Insurance Provider
Health Insurance Policy Number
Emergency Information
Emergency Contact
First NameLast Name
Phone Number
Area CodePhone Number
Relationship
Acknowledgement, Liability Waiver & Consent
I, the undersigned parent/guardian of the above camper understands that gymnastics is an active, physical sport and that injuries might happen. Any activity involving motion or height creates the possibility of serious injury, including permanent paralysis and even death from landing
or falling the head or neck.
I, the undersigned, do hereby grant the authority to the staff of [Organization Name] to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent or guardian. I authorize first aid, a medical or surgical diagnosis and treatment which may deem necessary.
I, the undersigned, release [Organization Name] and any of its coaches, staff, manager, and/or any parent for any responsibility in case of accident, illness, or injury during my child’s enrollment.
Date
MonthDayYear
Date
Parent or Guardian Printed Name
Parent or Guardian Signature
Payment Information
Payment
prevnext( X )
One Week Session$200.00

Two Week Sessions$400.00

Total $0.00
Should be Empty:

Gymnastics Camp Registration Form

Camper Information

Parent or Guardian Information

Medical and Insurance Information

Emergency Information

Acknowledgement, Liability Waiver & Consent

Payment Information