Joe's Planet Funastics Registration Form
**This form must be filled out and signed for you child to participate in gymnastics classes or camps.
Student's Name___________________________________________________ Phone #____________________
Address__________________________________________ City_______________ Zip Code ______________
Date of Birth ____________________ Age__________________ Gender_________________
Mother's Name_________________________________________ Contact #____________________________
Father's Name__________________________________________ Contact #____________________________
Email ___________________________________________________________________
Taught at: (ex..school/church/preschool)_____________________________________________
Student's Medical Information
Allergies (drugs, food, etc.) Yes__ No__ Seizures or Convulsions Yes__ No__
Serious Injuries (fractures, broken bones) Yes__ No__ Mental Disorders Yes__ No__
Birth Deformities (short leg, arm, etc.) Yes__ No__ Contacts or Glasses Yes__ No__
Any other information we may need to know to insure the safety of your child Yes__ No__
If you answered YES to any of the above questions, please explain below:
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
In the event of an emergency, if we are unable to reach you, whom would you like us to contact?
Name______________________________________________ Relationship____________________________
Phone #''s__________________________________________________________________________________
Release of Liability and Assumption of Risk
In consideration of the opportunity given my child to participate in gymnastics instruction classes, in connection with my enrollment of my child as a student in JOE”S PLANET FUNSATICS, and in recognizing that gymnastics is a sport involving height and motion, and like any other sport therein lies the possibility of accidental injury, I hereby knowingly, freely and voluntarily waive right of cause of action of any kind whatsoever arising as the result of such activity by the child either before, during, or after participating in his or her scheduled class or any other special event, from which any liability may or could accrue to JOE”S PLANET FUNASTICS, it's owners, agents employees and or instructor=rs.
___ I give permission for images of my child to be used by Joe's Planet Funastics for promotional purposes.
(please initial if you give permission)
I hereby certify that I have read the above and foregoing release and execute same this __________day of _____________20____.
Signature of Parent or Legal Guardian____________________________________________________________
**This form must be filled out and signed for you child to participate in gymnastics classes or camps.
Student's Name___________________________________________________ Phone #____________________
Address__________________________________________ City_______________ Zip Code ______________
Date of Birth ____________________ Age__________________ Gender_________________
Mother's Name_________________________________________ Contact #____________________________
Father's Name__________________________________________ Contact #____________________________
Email ___________________________________________________________________
Taught at: (ex..school/church/preschool)_____________________________________________
Student's Medical Information
Allergies (drugs, food, etc.) Yes__ No__ Seizures or Convulsions Yes__ No__
Serious Injuries (fractures, broken bones) Yes__ No__ Mental Disorders Yes__ No__
Birth Deformities (short leg, arm, etc.) Yes__ No__ Contacts or Glasses Yes__ No__
Any other information we may need to know to insure the safety of your child Yes__ No__
If you answered YES to any of the above questions, please explain below:
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
In the event of an emergency, if we are unable to reach you, whom would you like us to contact?
Name______________________________________________ Relationship____________________________
Phone #''s__________________________________________________________________________________
Release of Liability and Assumption of Risk
In consideration of the opportunity given my child to participate in gymnastics instruction classes, in connection with my enrollment of my child as a student in JOE”S PLANET FUNSATICS, and in recognizing that gymnastics is a sport involving height and motion, and like any other sport therein lies the possibility of accidental injury, I hereby knowingly, freely and voluntarily waive right of cause of action of any kind whatsoever arising as the result of such activity by the child either before, during, or after participating in his or her scheduled class or any other special event, from which any liability may or could accrue to JOE”S PLANET FUNASTICS, it's owners, agents employees and or instructor=rs.
___ I give permission for images of my child to be used by Joe's Planet Funastics for promotional purposes.
(please initial if you give permission)
I hereby certify that I have read the above and foregoing release and execute same this __________day of _____________20____.
Signature of Parent or Legal Guardian____________________________________________________________
