Gymnast Information *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Second Gymnast (sibling) *

Yes

No

Parents Name *

First Name

Last Name

Please check one of the following *

Mother

Father

Guardian

Phone *

(###)

###

####

USA gymnastics minor release and waiver of liability and indemnity agreement *

By signing this form and in consideration of participating in gymnastics events, I, for myself and as the minor’s parent and/or legal guardian understand the nature of this activity and participation involves risk of serious bodily injury, including permanent injury, paralysis and death which may be cause by my or the participant(s) actions or by the negligence of the “releasees” named bellow; and that may be other risk not known to me or foreseeable at this time; And I fully accept and assume all such risk and all responsibility for losses, cost, and damages that I or other listed individuals incur as a result of participating in the activity. If we believed the event conditions to be unsafe, we will immediately discontinue participation in the activity. I hereby release, discharge and covenant not to sue Gina’s Gymnastics LLC, its administrators, directors, officers, employees, volunteers, other participants, and if applicable, owners and lessors of premises on which the activity takes place. I HAVE READ THE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT.

I agree to the terms