Student’s Name_____________________________ Age_____
Date of Birth_________________

Address___________________________________ City___________________State_________

Mother___________________________________ CellPhone____________________________

Father___________________________________ Cell Phone____________________________

Any known medical conditions______________________________________________________

______________________________________________________________________________

______________________________________________________________________

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 can occur and risk is involved in any athletic activity, especially gymnastics, which involves both height and motion. I further agree that Spivey’s Gymnastics International, Inc. along with its employees, agents, officers and directors shall not be liable for any damages of losses occurring as a result in my child’s participation in gymnastics, including transportation to and from activities, except where such damage is the result of the intentional or reckless conduct of one of the above mentioned individuals.