FIRECRACKER CAMP

2008 REGISTRATION FORM
This form can be completed with your keyboard

How did you hear about us?

Registering for Camp #1 June 9-13 Registering for Camp #2 July 14-18
Anticipated Level of Student at Time of Camp

1. Name Age Date of Birth

2. Name Age Date of Birth

3. Name Age Date of Birth

T-Shirt Size 1. 2. 3.

Address

City State Zip

Home Phone

Cell Phone Emergency Phone

Email

Make checks payable to: CINCINNATI GYMNASTICS ACADEMY
Deposit Due at time of registration - $50 Non-Refundable
Balance Due by the first day of Camp

MEDICAL RELEASE AGREEMENT AND PARENTAL CONSENT

Students are expected to carry their own accident and/or medical insurance. Coaches and instructors of the Cincinnati Gymnastics Academy are safety conscious and follow appropriate safety procedures. In the event of injury or illness, every effort will be made to contact the parents or guardian. If necessary, I authorize Cincinnati Gymnastics to administer first aid and / or authorize medical treatment if this becomes necessary. The above named student has had a medical examination within the last twelve months and is capable of participating in the sport of gymnastics.

Parent or guardian signature Date

Emergency contact if parent or guardian cannot be reached call:
Name Phone

Please drop off the registration form at our office or mail to:

Cincinnati Gymnastics Academy
3635 Woodridge Blvd
Fairfield, OH 45014

HOMEPAGE