Child’s Name: _________________________________________________ Age: _________

Date of Birth: ___________________

Child’s Name: _________________________________________________ Age: _________

Date of Birth: ___________________

Phone Number: (_____) __________________ Emergency : (_____) ___________________

Cell Phone or Pager # (_____) _________________________

E-mail Address: _______________________________________________________________

Address: _____________________________________________________________________ City/State___________________________________________ Zip: ________________

Father’s Name: _________________________Mother’s Name:__________________________

Any medical problems we should be aware of? _____________________________________________________________________________

In consideration of the agreement of Cincinnati Gymnastics Academy (hereinafter CGA) to accept my child(ren) (hereinafter participant) as a participant in CGA activities, the parent or legal guardian of said participant hereby states that they understand that any activity involving height, motion, or rotation in an unique environment may cause the possibility of accidental injury, paralysis and even death. The undersigned voluntarily assume the risk of such injury to participant, his or her heirs, executors, successors and assigns from any and all liability, actions, claims and causes of action whatsoever on account of or in any way related to the participation or participant in CGA activities and does hereby agree to fully indemnify CGA for any medical expenses or other damages resulting from any such accidental injury to participant while training or performing at or for CGA, except where such expenses or damages are the result of the intentional or reckless conduct of CGA.

On many occasions newspapers, TV stations, etc., will visit CGA. They often take picture or videos of our classes or teams. Signing this release will include giving permission for us to possibly use you or your child’s picture in promotion and advertising for the gym. It is understood that no compensation will be given by the gym or by the user of such picture.

This agreement and waiver having been read thoroughly and understood completely, is signed voluntarily as to its content and intent. I HAVE RECEIVED AND READ A COPY OF ALL CINCINNATI GYMNASTICS ACADEMY POLICIES AND AGREE TO ADHERE TO THEM, INCLUDING NO REFUNDS.

I give Cincinnati Gymnastics Academy my permission to transport my child:

(Name)__________________________________to (Hospital)____________________________ for emergency medical or to (Dentist, clinic)______________________________for emergency dental, or to the nearest available source of assistance.

Parent’s Signature: _________________________________________

Date____________________________

(List any facts to which a physician should be alerted): ____________________________________________________________________________________________________________________________________________________________

Class Cancellation Policy - Classes are based on a minimum of 3 students and are subject to cancellation if we do not reach our minimum.

Instructors – Although we make every effort to have a consistent instructor within an 8-week term, we do not guarantee that instructors will remain in their position as listed in our schedule.

CGA Card - By attending 6 consecutive terms (depending on when you enroll) – CGA rewards our customers with a CGA (Customer Get Appreciated) card that entitles you to a free overnight for your school-age child or $10 off from our pro-shop. Please make sure that you have your card stamped each time that you re-register.

Holiday Make –up Policy – CGA will be closed for all major holidays. For holidays that occur on your scheduled class day, Classroom and Preschool students will receive an Open Gym Pass to replace the missed class.

Family Discount – 10% for 2 or more immediate family members enrolled in classes. Homeschool students are not eligible for this discount.

Refund/Credit Procedure - * No refunds will be given after the first day of any Term. In the event that injury or family emergency does occur, we will make every effort to work with you to re-schedule your class.

Parent Observation – All parents are invited to observe whenever it is convenient. We recommend 2 visits per term.

Class Attire – Girls should wear a leotard, hair back and no jewelry, no stockings or socks. Boys should wear gym shorts and a t-shirt.

Make-up Procedure – In the event your child cannot make their regularly scheduled class, they may pick up a pass at the office to attend Classroom/Pre-School Open Gym at no charge on the Sunday of your choice to replace the missed class.

I have read and understand the above policies and procedures. __________________________________________________

Parent Signature

We will occasionally use photographs of the children on the Cincinnati Gymnastics web site, presentations, and local newspaper articles. The photos will consist of casual shots taken while the children are at the gym. Please sign below giving or withholding permission for your child’s photo to be used. NO names, addresses, or other personal information will be used.

______ YES! I give my permission to Cincinnati Gymnastics to photograph my child and use the picture on the web site and/or for special presentations and/or in local newspapers.

______ NO! I do not give Cincinnati Gymnastics permission to photograph my child