Child’s Name______________________________ Age____
Date of Birth __________________
Address______________________________________
City _______________ State _________
Mother_______________________________________ Cell
Phone____________________
Father_______________________________________ Cell
Phone________________________
Any known medical condition/food
allergies___________________________________________
______________________________________________________________________________
______________________________________________________________________________
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 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 the
employees, agents, officers and directors shall not be liable for
any damages or losses occurring as a result of 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.
Parent’s Signature_______________________________________
Date___________________________