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__________________________________

Emergency Contact Name______________________________________

Emergency Contact Phone______________________________________

Registration Fee

Grand Rapids Gymnastics Academy charges a one-time registration fee of $25 per family.   In April of each following year, GRGA charges a $15 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 Academy

Special Events Waiver

Your 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 Waiver

By 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)___________________

      _______________________________________________________________

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_______________