Green Mountain Gymnastics
Tiny Tumblers Open Gym and Open Gym Workout Class
Waiver/Release Form 2009/2010

First Name of Child Last Name of ChildDate of Birth:Gender:




   Male
  Female






   Male
  Female






   Male
  Female
Address:

City:

State:

Zip:

Last and First Names TelephoneCell Phone
Parent:





Spouse/Partner:





Email address:

Emergency Contact Name (other than parent):


 Emergency Contact Phone:


**Please note: This form will be kept on file and will cover only the "Tiny Tumblers Open Gym: from Aug 31st, 2009 - Aug 31st, 2010

Note: Only those registered allowed on equipment!

Agreement
In consideration of my child's participation in Green Mountain Gymnastics Inc. (further referred to as GMG) events and activities, I hereby agree to be bound by each of the following terms and conditions:

  1. Eligibility: I agree to comply with the rules of GMG.
  2. Medical Attention: I hereby give my consent to GMG and/or host Organization to provide, through a medical staff of choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of my participation in the event, except where such loss or damage is the result of the intentional or reckless conduct of one of the organizations or individuals identified above.
  3. Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses associated with participation in gymnastics activities and events.

I further agree that GMG and the sponsor of any GMG event, along with the employees, agents, officers and directors of these organizations, shall not be liable for any losses or damages occurring as a result of my/our child's participation in any GMG event or activity, except where such loss or damage is the result of intentional or reckless conduct on one of the individual (s) /organization (s) mentioned above.

What to wear: Shorts, sweat pants, t-shirts. Please do not wear clothing with buckles, snaps or zippers. No watches or jewelry allowed on floor. We are not responsible for lost or stolen merchandise.

Signatures of Both Parents/Legal Guardian(s), Custodial Parent(s):

_____________________________________     _____________________________________

Green Mountain Gymnastics, 240 Pioneer Drive, Williston, VT 05495
(802) 652-2454
Robin@GreenMountainGymnastics.com