OPEN GYM
CONSENT REGISTRATION FORM

Child’s Name ______________________________________

Parent’s Name ________________________________________________________

Address: __________________________________________

Phone:__________________________

Emergency Contact & Phone: _____________________________________________________________

I authorize Woodlands Gymnastics Academy (WGA) to consent to medical treatment for my child in the occasion that I cannot be reached. I am aware that any activity involving height or motion creates the possibility of injury and I further agree to hold WGA and its staff harmless for any injury or resulting expenses. I release and discharge any and all rights and claims against WGA, and its parties. Please note that we carry insurance, but this coverage pays the medical expenses actually incurred by a participant when an accidental injury occurs while participating in covered club activities. The coverage is excess coverage and begins after the exhaustion of all other coverage for which the participant may be eligible. If no other coverage exists, this coverage becomes primary, after the deductible has been paid.

Signature of Parent or Legal Guardian: _____________________________________ Date: ____________