New registration – Coastal Gymnastics

Coastal Gymnastics Registration

Coastal Gymnastics Registration

Gymnast's Name

Name

Name

First

First

Last

Last

Birth date

Month

Day

Year

Age

Gender

Female

Male

Parent / Guardian Info

Name

Name

First

First

Last

Last

Street Address

Street Address 2

City

State

Zipcode

Cell Phone

Email

Emergency Contact Infomation

Emergency Contact Name

Emergency Contact Name

First

First

Last

Last

Relationship

Text

Cell Phone

Alternate Phone

Does the gymnast have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the gymnast prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Coastal Gymnastics during the selected camp. In exchange for the acceptance of said child’s candidacy by Coastal Gymnastics. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Coastal Gymnastics, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Coastal Gymnastics, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including gymnastics. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death. Medical Release and Authorization As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Coastal Gymnastics and its affiliates, including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence. Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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