OPEN GYM RELEASE

Student Name: _______________________________Date of Birth: ______/______/_____

Address: _______________________________

City/State/Zip _______________________________Home Phone: ( ) _____________

_______________________________

Parent's of minor students - Please complete the section below.

All Students:

Please complete the information below so that we can act quickly in the event of an accident.

Emergency Contact (for children list a someone to call in the event we cannot reach the parent):

Name/Relation: ________________________________Phone Number: ( ) _____________

Physician's Name:______________________________Phone Number: ( ) _____________

Medical Insurance Co.:_________________________Phone Number: ( ) _____________

Insurance Number: _____________________________

List any allergies/intolerance to medications: ______________________________________

Describe any illnesses or previous injuries of which we should be aware: _____________________________________________________________________________

If so, are there any medical restrictions? ______________________________________

I fully understand that Rainbow Gymnastics; Inc. staff is NOT physicians or medical practitioners of any kind. With this in mind, I hereby release the staff of Rainbow Gymnastics, Inc. to render temporary first aid to myself/my child (ren) in the event of any injury/illness and If deemed necessary by the Rainbow Gymnastics, Inc. staff, to call the doctor and seek medical assistance, including transportation by a staff member and/or its representative, whether paid or volunteer, to any health care facility or hospital. This includes the calling of an ambulance for transport should the Rainbow Gymnastics, Inc. Staff deems this necessary.

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Signature (parent or guardian if student is a minor) Date

We the Rainbow Gymnastics, Inc. staff recognize our obligation to make our students/parents aware of the risks and hazards associated with the sports of gymnastics, dance, cheerleading, martial arts and fitness exercise. Students may suffer injuries, possibly minor, serious or catastrophic in nature. Gymnastics, tumbling, cheerleading, martial arts and fitness can be dangerous and can lead to injury!

Adults should be aware and parents should make their children aware of the possibility of injury and to follow all of the safety rules and coaches instruction.

Rainbow Gymnastics, Inc. its coaches and staff members will not accept responsibility for injuries sustained by any student during the course of gymnastics, tumbling, cheerleading, martial arts and fitness exercise, competition or clinic in which he/she may participate including travel to and from the event.

With the above in mind and being fully aware of the risks and possibility of injury involved, I consent to or give consent for myself or my child (ren) to participate in the programs offered by Rainbow Gymnastics, Inc. I, my executors or other representatives, waive and release all rights and claims for damages that I and/or my child(ren) may have against Rainbow Gymnastics, Inc. and or its representatives whether paid or volunteer.

I also confirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage that I consider adequate for me and/or my child (ren)s protection.

I also understand, if applicable, that as the parent/guardian of minor students, it is my responsibility to warn the child (ren) about the dangers of gymnastics, tumbling, cheerleading, martial arts, and fitness exercise and of the potential for injury. The parent should warn the child according to what the parent feels is appropriate. Rainbow Gymnastics, Inc. staff will only warn the students through "Safety Messages", or teaching style and progressions.

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Signature(parent or guardian if student is a minor) Date