AMERICAN TURNERS NORTHWEST CHICAGO

GYMNASTICS REGISTRATION

 

First Name________________________      Last Name ______________________________

 

Address__________________________       City __________________     Zip Code__________

 

Age__________          Birth Date_________________      Medical Conditions ________________

 

Mother’s Name_____________________     Phone Number _____________________________

 

Father’s Name _____________________     Phone Number_____________________________

 

E-Mail ____________________________    Turner Member?____________________________

 

How did you find out about us? ___________________________________________________

 

EMERGENCY CONTACT

 

Name _____________________   Relationship _______________   Phone __________________

 

CLASS INFORMATION

 

Class ______________________   Registration Date ___________________________________

 

RELEASE AND HOLD HARMLESS AGREEMENT

Parent of participants under the age of 18 should read this form carefully and be aware that in registering for and participating in this program, you will be waiving and releasing all claims for injuries or damages you might personally sustain arising from this program.

 

As a parent of a minor participating in this program, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, damages, or loss which I may sustain as a result of my minor child’s participation in such programs as against the American Turners-Northwest Chicago, its officers, agents, servants, and employees.

 

I do hereby fully release and discharge the American Turners-Northwest Chicago and its officers, agents, servants, and employees from any and all claims from injuries, damage, or loss which I may have or which may accrue to me as a result of my minor child’s participation in this program.

 

I further agree to indemnify, hold harmless and defend the American Turners-Northwest Chicago and its officers, agents, servants, and employees from any and all claims resulting from injuries, damages, and losses sustained by me and arising out of, connected with, or in any way associated with the activities of the program (or with my minor child’s participation in the activities of the program).

 

I have read and fully understand this Release and Hold Harmless Agreement.

 

Signature _____________________________________         Date ______________________

 

Print Name ___________________________________

 

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