Athlete Tumbling Waiver

Athlete Name *

First Name

Last Name

Guardian Name *

First Name

Last Name

Athlete's Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Contact #1 Name *

First Name

Last Name

Contact #1 Phone *

(###)

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Contact #2 Name

First Name

Last Name

Contact #2 Phone

(###)

###

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Has the participant ever had an injury, accident, allergy, or condition requiring ongoing medical attention? *

Yes

No

Does the participant have any physical, mental, or medical conditions that, for safety reasons, should be disclosed? *

Yes

No

By signing this form, I acknowledge that I am aware that there are risks associated with gymnastics. I warrant that the participant named on this information form is physically fit to participate in gymnastics. I declare that I have accurately disclosed all information regarding physical, mental or medical conditions affecting the named participant and acknowledge that this information may be used by the Loyalist Gymnastics Club (LGC)/Gymnastics Ontario (GO) in the delivery of a gymnastics program. I acknowledge that there is a potential risk for injury involved in any sport. I understand that LGC/GO has tried to create a safe and controlled environment for participation and that LGC has established rules for participation in and about the gymnastics area that must be followed by the participant. I understand that failure to comply with any of the policies and rules of LGC may result in the suspension or termination of membership. I waive the rights of the participant to damages or other costs in the event injury is caused due to participation in gymnastics or other involvement with the federation. I understand my responsibility to ensure that the information on this form is kept current and I will notify the club of any changes promptly. If all requested information is not provided, the applicant will not be permitted to participate. *

I agree to terms

I do NOT agree to terms

Please provide your signature by typing your full name in the designated field below. By doing so, you are confirming that you understand and agree to the terms and conditions outlined in this document. Your typed name will be considered as your legal signature. *

First Name

Last Name

Date *

MM

DD

YYYY