Student’s Name _________________________________________________________________________

Last First

Sex __________

Date of Birth _______________________________

Mailing Address _________________________________________________________________________

City _______________________________________ State ___________________Zip ________________

Home Phone ______________________ E-Mail _____________________________________

Cell Phone ________________________

Mother’s Name _________________________________ Work Phone ________________________

Father’s Name __________________________________ Work Phone ________________________

How did you hear about us? ____________________________________________________________

ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABLILITY and

AGREEMENT NOT TO SUE

As a parent/legal guardian of _______________________________________, hereby give consent for him/her to participate in Desert Thunder Gymnastics programs. I recognize that potentially severe injuries can occur in any activity, including gymnastics, which involves height and motion. I realize that my child will be training and performing on all gymnastics apparatus and events, plus other training devices, including trampoline.

I understand it is the intent of Desert Thunder Gymnastics to provide for the safety and protection of my child. And in consideration for allowing my child to use these facilities, I hereby release Desert Thunder Gymnastics, it officers, employees, coaches, and staff from all liability from any and all damages and/or injuries while under the instruction, supervision, or care of Desert Thunder Gymnastics and its employees.

As parent/legal guardian of ___________________________________________, I hereby agree to provide for medical expenses incurred by this person as of any injury sustained while training or performing at or for Desert Thunder Gymnastics.

I certify that my child is in good physical condition and is capable of participating on the Desert Thunder Gymnastics program. Please list any medical conditions we should be aware of. _______________________________________________

_______________________________________________________________________________________________________________

In the event of an emergency where I cannot be reached, please notify ________________________________________________

At phone # __________________________. I hereby authorize Desert Thunder Gymnastics to seek medical treatment, in the event that I cannot be reached.

The physician/medical facility for my child is _________________________________________ at Phone___________________________.

This Acknowledgement of Risk and Waiver of Liability and agreement not to sue, has been read thoroughly and understood fully as to its content and intent, and is being signed voluntarily.

Parent/legal guardian ______________________________________________________ Date _____________________