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Spivey's Gymnastics
61 S Jackson St
Winder, GA 30680-2014
770-586-5797 |
Birthday Party Release Form
Student’s Name_____________________________ Age_____
Date of Birth__________Sex____
Address____________________________________City___________________State_________
Home Phone________________________________
Mother__________________________ Work Phone______________ Cell
Phone____________
Father__________________________ Work Phone ______________ Cell
Phone____________
Special instructions or medical
concerns______________________________________________
______________________________________________________________________________
ACKNOWLEDGE OF RISK AND WAIVER OF LIABILITY
I hereby consent to my child participating in the
programs of Spivey’s Gymnastics International, Inc.
I understand that injuries can occur and there is risk involved in
any type of athletic activity which my child may be involved,
especially gymnastics activity that includes both height and motion.
I further agree that Spivey’s Gymnastics International, Inc., along
with the employees, agents, officers and directors shall not be
liable for any losses or damage occurring as a result of my child’s
participation in gymnastics, including to and from activities,
except where such damage or loss is the result of the reckless or
intentional conduct of one of the above mentioned individuals.
This acknowledgement of RISK AND WAIVER OF LIABILITY has been
read and signed voluntarily.
__________________________________________
___________________________________
Parent or Guardian Signature
Date
