Child’s
Name:
_________________________________________________________ Birth Date: ___________________________
Age: _________Phone:
_______________________________ Has this child been to Nittany before? Yes
No
Parent’s Name:
________________________________________________________________________________________
Address: __________________________________________City: _______________________ State: _____ Zip: __________
IN
CASE OF EMERGENCY, PLEASE CONTACT (Other than parent’s):
Name:
___________________________ Phone: _________________
PLEASE NOTE ON REVERSE SIDE ANY SPECIAL MEDICAL
CONDITIONS, ALLERGIES, HANDICAPS, ETC., OF WHICH THE NITTANY STAFF SHOULD BE
AWARE.
***FOR INSURANCE REASONS, PARENTS ARE NOT ALLOWED IN THE GYM***
We, the staff of Nittany Gymnastics Academy recognize our obligation to make our students and their parents aware of the risks and hazards associated with the sport of gymnastics, trampoline, tumbling, cheerleading and physical education and sports instruction. Students may suffer injuries, possibly minor, serious or catastrophic in nature. Gymnastics, trampoline, tumbling, cheerleading and physical education and sports instruction can be dangerous and can lead to injury.
Parents should make their
children aware of the possibility of injury and encourage their children to
follow all the safety rules and the coaches’ instructions. Nittany Gymnastics
Academy, its coaches and other staff members will not accept responsibility for
injuries sustained by any student during the course of gymnastics, trampoline,
tumbling, cheerleading or physical education and sports instruction, or open
workouts or in the case of any exhibition, competition, or clinic in which he or
she may participate or while traveling to or from the event. With the above in
mind, and being fully aware of the risks and possibility of injury involved, I
consent to have my child or children participate in the programs offered by
Nittany Gymnastics Academy. I, my executors or other representatives, waive and
release all rights and claims for damages that I or my child may have against
Nittany Gymnastics Academy and/or its representatives whether paid or
volunteer. I also affirm that I now have and will continue to provide proper
hospitalization, health and accident insurance coverage, which I consider
adequate for both my child’s protection and my own protection. I also
understand that it is the parents’ responsibility to warn the child about the
dangers of gymnastics and injury. The parent should warn the child according to
what the parents feels is appropriate. Nittany Gymnastics Academy will only
warn the child through our student handbook, posted safety rules and our
teaching style and progressions.
Parent’s
Signature________________________________________________________________
Date_______________________________