Form

AA GYMNASTICS TRAINING CENTER
REGISTRATION FORM

Thank you for choosing AA Gymnastics! You may use one form to register every student in your family.
EMAIL Please enter email address you will use for all communications.
Email*
STUDENT & FAMILY INFORMATION
Last Name*
Address*
City*
State*
Zip*
Phone*
Please enter the mobile phone number you would like to use for SMS (text messages) regarding class/schedule changes and other information from the gym.
Mobile*
Student1 Firstname*
Student1 Birthday (MM/DD/YY)*
Prior Gymnastics Experience
Beginner/Recreational (#years) or Team Level
Student(s) Live with?

Both Parents

Mother

Father

Other
Use the space below to add additional students. If no additional students, please skip to Parent Information
Student2 Firstname
Student2 Birthday
Student3 Firstname
Student3 Birthday
Student4 Firstname
Student4 Birthday
PARENT INFORMATION
Parent Name*
Parent Mobile
Parent Name2
Parent Email2
Parent Mobile2
Referred to AA by?
INSURANCE INFORMATION
Insurance Company/Phone #
Insurance Group#/Policy#
Personal Responsible for Insurance
LIABILITY RELEASE & MEDICAL INFORMATION

please read both statements below
Agree to Liability Statement*
Agree to Medical Release*
Agree to Photo/Video User Release *

LIABILITY RELEASE STATEMENT
I represent that I am the parent or legal guardian of the minor child(ren) below. I understand the risk of serious injury from any physical activities, including gymnastics activities, hereby voluntarily and knowingly execute this release with the express intention of effecting the extinguishments of and complete release from AA Gymnastics Training Center, its coaches, staff or instructors, arising from any and all injury or physical harm which may arise from or be sustained as a result of the participation of my children, myself, other family members, or legal wards in gymnastic, tumbling or dance instruction of and physical activity associated with and related to activities at AA Gymnastics Training Center.

MEDICAL RELEASE
I authorize the directors of AA Gymnastics Training Center to obtain all medical assistance for my minor child/legal ward. I authorize any necessary emergency attention given by emergency responders, a physician or hospital when so requested by a member of the AA Gymnastics staff. This authorization is given on local situations wherein a parent or legal guardian cannot be reached, and in the event of an emergency developing out of town, and the parents cannot be reached without long delay.

Photo/Video Use Release Form

I,hereby grant and authorize AA Gymnastics Academy, LLC the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of my child(ren) to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of AA Gymnastics Academy, LLC and will not be returned. I hereby hold harmless, and release AA Gymnastics Academy, LLC from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.

* required information