Form A Gold Medal Gymnastics Enrollment Form ‘Snudents Name Date of Birth, Date of First Class, (Anniversary Date) Couch lass Level Day & Time : Address iy. state Zip. Home Phone $17), Mothers Work Phone(417). Fathers Work Phono(417). Parents Place of Employment, Cell Phones & Pagers or Others Ways of Contact E-Mail Address, Previous or Existing Medical Conditions J understand there is risk of injury involved with any activity and I hereby authorize medical care and treatment for my child. in case of accident or injury. I will not hold staff or management of Gold Medal Gymnastics responsible for such accidents or injuries if medical attention is sought. Print Name of Parent or Guardian x - (Parent or Legal Guardian's Signature) Fees PaidLL Gna ‘Minor Release and Waiver of Liability and Indemnity Agreement ol aly ete Sin) For Minor Parcipting he A est, Crew, Even Specialist and Volunteer {o ederation of beng perited to particpat In any way in the Gnas Praram tet dow an hing permite te any puro ay rented are (here dtd any aren where nace to thee ble relate Ae pean eat ‘Aus of che nino partiant wnaed tow are 1 pace] aor etl guaran wl het the nar parent tht por eo partie in th low emai tity mre ew he aul inspect he fies nd wotpnent toe wo, andi be ort elves anging ee the ore deca Tarn th onl of ch condition si fot arta. undernar ai aes tha, tt ans ie letersi wil mediately tke al precautions to sid the wast re and REFUSE TO FART IChPAT th 2 Wt fly nr ad sche that (or Tes nd gr ced with erp byes cv and atts whch esl elite slr dit, passin and death, (1) Th aril nl eons nse an damage, which col oul rom the risa gr verti she, en he ener (er These nd dean be ers by the on, ton or neigence the cp wt set, Han heal hrs, hang, bt ie, Rese named elo, {4 There may heer sks not how tte eal ot hi tne TARY mc an asa stl ik iad erator hha ards flees ays, yoo dehy Iwomerer ene and whether ened in whole or yart by the dee of he Hekcses ta Arrertty RELEASE, WAIVE, PICILANGE AND COVENANT NOT-TO SUB he Amma or gasite xty s ythe wince cer acting ts mers anager, proms, laces of premised to cut th easton ev nace rineter underwriter, conaltans ad aber who give esommendaons,detlns, we metins cose ek ea tise gee earn the Ammann ornate fat or eens Bell at euch mata fase od raat ery, kets employer, al fr the puro heen refereltaa Relense™ ROMA LR A OR ER ARINED, fou rersnal representa ain, executrs, blr a cao Ke POR ANY AND ALL CAA eh aoe Ser AGES AND ANY CLAMS OR DEMANDS THEREFORE ON ACCOLNT OF ANY INJUNY, NCLAIING AUT Ree ane a Ot cate PAKTICNANT OR DAMAGE.TO PROPERTY, AUSING OUT OF OR RELATING TO TIREVENTISN ALgN cose en Oe CAUSED IN WHA OLIN PART BY THE NEGLIGENCE OF THR REL.EASHE OK Teen sree tests ht TH ACTIVITIES OF TH E¥ENT(S) AME VERE DANGEROUN a nee th ih ea ar ul Popeater? dae: ach of TIE UNDERSIGNED aa exe acknonten int RIUINES HECEER SG FOUNDED OR INGKUASRD IY NEGLIGENT RESCUE OPERATIONS OK PROCRDURES OF Tile thee Heald kag RESIN tar expen es tht hfe leeway, linen enc tend yb saa cv termed ky Ue lvoe Prove ate lich teem Weomiuced sol Re aa ‘wo sade hat the alan hall twisting sun fallogd Ree ent te averse enc trata inhale wei art) an tl fuss for hemo aeons hn irc tes tt hes th ptt me dn at ny ate Reet he prea eae ‘iri the ele for any money which hy hase othe pareont non s e e ad s e TERI ER ee AND WAIVER OF GABA, ASSUMPTION OF RISK AND INDSINTY ARENT. FLY UNMERSTAND TART TRIO AT TAVECIVEN Wo SUDSEANTIAL RIGHTS BY SUNG TE AND IAG MNFRS a Tete A ETRY NOUCEMENT, ASSURANCE OR GUARANTEE BEING MAN TO ME ANN NVA noua Te "PETTR AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THI GREATEST EXTUNT ALdaNVED Ne Lea ei eae ee ee Beane ee ee (Remeron Moire =e _ lay rl ee ee Sn ee ee Receive by Tata eset