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Home
About Our Program
Our Staff
Our Facility
Contact Us
Classes & Pricing
Competitive Team
Bombers Team Shutterfly ShareSite
Sign Up for Competitions!
Sign up to Help at Meets
Team Events & Meet Schedule
Birthday Parties
Competitive Team Health Form & Waiver
Gymnasts Information
*
Indicates required field
Name
*
Age
*
Birthdate
*
00/00/00
Address
*
City, State, Zip
*
Home Phone
*
Team T-Shirt Size
*
CS
CM
CL
AS
AM
AL
AXL
Health Information
Special Limitations or Concerns
*
Any Weaknesses in Bones, Joints, Muscles or Organs?
Chronic Health Conditions
*
Illnesses, Allergies, Respiratory, Circulatory, etc?
Taking Medications or Medication Allergies?
*
Doctor's Name/Office
*
Phone Number
*
000-000-0000
Insurance Carrier
*
Insurance #
*
Parents/Guardians Information
Parent/Guardian 1
*
Parent/Guardian 1 - Cell Phone #
*
Parent/Guardian 2
*
Parent/Guardian 2 - Cell Phone #
*
email Address
*
Parent T-Shirt Size
*
CS
CM
CL
AS
AM
AL
AXL
AXXL
3X
4X
In case of emergency, and we are unable to reach the parents/guardians, please provide an alternate contact:
Name
*
Phone #
*
Relationship
*
Waiver Information
I authorize the YMCA of Greater Westfield to use my child’s photo/image for marketing and promotion purpose
*
Yes
No
I understand that every effort will be made to reach me in case of emergency. If I am unable to be contacted, I hereby authorize the staff at the YMCA of Greater Westfield to act in my absence according to their best judgement in any emergency requiring medical attention, and hearby waive and release the YMCA from any and all liability for any injuries incurred during the gymnastics season. I understand that participation in gymnastics involves motion, rotation and height in a unique environment and as such carries the risk of injury. I hereby authorize qualified medical personnel to administer necessary emergency treatment to my child in the event of an accident in which I cannot be reached. By signing below I authorize my child to participate in the YMCA gymnastics program and understand and agree to the terms and conditions.
*
I Have Read & Understand
Parents Signature
*
Date
*
00/00/00
Submit
Home
About Our Program
Our Staff
Our Facility
Contact Us
Classes & Pricing
Competitive Team
Bombers Team Shutterfly ShareSite
Sign Up for Competitions!
Sign up to Help at Meets
Team Events & Meet Schedule
Birthday Parties