Seacoast Gymnastics Center
I understand that Seacoast Gymnastics Center (SGC) staff members are not physicians or medical practitioners of any kind. With this in mind, I release the SGC’s staff to render temporary first aid to my child or children in the event of injury or illness, and if deemed necessary by SGCs staff, to call our doctor and seek medical help, including transportation by a SCG’s staff member and/or its representatives, whether paid or volunteer to any health care facility or hospital, or the calling of an ambulance for said child.
We, the staff of SGC’s, recognize our obligation to make our students and their parents aware of the risks and hazards associated with gymnastics, tumbling and cheering. Students may suffer injuries, possibly minor, to serious or catastrophic in nature. Gymnastics, tumbling and cheering can be dangerous and lead to injury! Parents should make their children aware of the possibility of injury and encourage their children to follow all safety rules and the coaches’ instruction. SGC, its coaches and other staff members, will not accept responsibility for injuries sustained by any student during the course of gymnastics, tumbling, cheering instruction or open gym, or in the course of any exhibition, competition, or clinic in which he or she may participate, or while traveling to or from an event.
With the above in mind, and being fully aware of the risks and possibility of injury involved, I consent to have my child or children participate in the programs offered by SGC. I, my executors, or other representatives, waive and release all rights and claims for damages that I or my child may have against SGC and/or its representatives whether paid or volunteer.
I affirm that I now have, and will continue to provide, proper hospitalization, health and accident insurance which I consider adequate for my child’s protection and my own protection. I understand it is the parents’ responsibility to warn the child about the dangers of gymnastics and the risk of injury. The parent should warn the child according to what the parent feels is appropriate. SGC will only warn the child through “Safety Messages”, our teaching style and instructional progressions.
1st Child’s Name: ________________________________________________________ Age: _______ Date of Birth: _____________________
2nd Child’s Name: _____________________________________________________________ Age: ________ Date of Birth: ________________________
Parent/Guardian: _____________________________________________________ Phone:___________________________________________
Address: ___________________________________________________________ City: __________________ Zip Code: ______________
Class Day/Time: _____________________________________________________ New Student? __________
Insurance Co. _____________________________________________ Email____________________________________________
Signature of Parent or Guardian Date
(603) 332-9821 The Lilac Mall, 13 Milton Road, Rochester, NH 03867 email@example.com