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Home
About Us
Recreational Gymnastics Classes
Registration Form
Xcel Program
DP- Compulsory Program
DP- Optionals Program
Contact Us
Team Parent Portal
Menu
Registration Form
Rec Class Registration Form
Class Day & Time Requested
Class/Level
Tiny Tumblers
Mountain Climbers
Summit Seekers
Flipstars
Mt Everest
Snowballs/Hotshots
Boys
Adult Gymnastics
Cheernastics/Tumbling
Gymnast Name
*
Gymnast Name
First Name
First Name
Last Name
Last Name
Date of Birth
*
Age
*
Female or Male
*
Female
Male
Gymnast #2 Name
Gymnast #2 Name
First Name
First Name
Last Name
Last Name
Date of Birth
Age
Female or Male
Female
Male
Parent 1 Name
*
Parent 1 Name
First Name
First Name
Last Name
Last Name
Phone
*
Email
*
Parent 2 Name
Parent 2 Name
First Name
First Name
Last Name
Last Name
Phone
Email
Street Address
*
City
*
State
*
Zip
*
Emergency Contact
*
Emergency Contact
First Name
First Name
Last Name
Last Name
Phone
*
Email
*
Medical Insurance Company (Primary)
Plan/Group Number (Primary)
Primary Insured
Allergies
Doctors Office
Physician Name
Phone
Preferred Hospital
I hereby authorize Mountain West Gymnastics, to seek emergency medical treatment for my child if I cannot be reached. This release does not include non-emergency or elective surgery.
*
Yes
In Consideration of the agreement of Mountain West Gymnastics Inc., (hereafter MWG) to accept the above named child (hereafter referred to as a participant) as a participant in MWG activities, the parent or legal guardian of said participant hereby state that they, he/she, understands that any activity involving height, speed, motion and flipping contain the possibility of accidental injury, and that he/she voluntarily assumes the risk of such injury. Further, I am aware and fully understand that gymnastics is a vigorous sporting activity and poses a risk of injury. I understand that gymnastics and other related activities always and inherently involve certain risk, including but not limited to: death, serious neck and spinal cord injuries resulting in complete or partial paralysis, brain damage and or serious injury to virtually all bones, joints, muscles and internal organs of the body. It is also understood that landing mats, pits and other safety equipment including the active participation of the safety spotter MAY be inadequate to prevent injury. In other words, the risk of harm may be limited by the safety equipment and coach participation, BUT NEVER ELIMITATED. I am voluntarily allowing participation in this activity with the knowledge of the risks involved and hereby agree to accept any and all risks of personal injury, property damage and even death. In consideration of this participation in MWG activities, I hereby release MWG Inc., its Board of Directors and Officers, the employees of MWG from any and all future claims resulting from injury to participant at any MWG activity. I affirm that I am of legal age, or the parent/legal guardian of the minor child listed above that I am freely signing this agreement. I have read this form and fully understand that by signing this form, I am releasing MWG of all future claims that may arise due to injury during participation in any MWG event or activity. On occasion, newspapers, T.V. Stations, etc. will visit MWG, often taking photos or videos of our team or recreational children. Signing this release includes your permission for us to use you or your child’s likeness in promotion and/or advertising for the gym. It is understood that no compensation will be given by the gym or by the user of such photos or videos. This waiver/agreement, having been read through and understood completely, is signed voluntarily as to its content and intent.
*
Yes
Parent/Legal Guardian Signature
*
Parent/Legal Guardian Signature
First Name
First Name
Last Name
Last Name
Date
*
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