Student Registration Information 2009-2010

Students Name: _____________________________ Sex: ___Age: ___DOB: __/__/__

            Address:  ___________________________________   School ________________

              City: ___________________________ State: _____   Zip: ____

            Phone: _________________ Emergency Phone _____________________

               Mother’s Name: _________________________________ Cell   ________________

               Father’s Name:  _________________________________ Cell   ________________

               Email address: ___________________________ May we invoice via email?  Yes / No

            Class Information:

             1^st Class ________________________________ Day: ________ Time: _________

                   (Additional Classes 5% discount applies)

              2^nd Class ________________________________ Day: ________ Time: _________

              3^rd Class ________________________________ Day: ________ Time: _________

             Enclosed the Annual Registration Fee ($40.00/sibling $30.00)                $_________

           Tuition Fee: Fall ______ spring _____ summer______                                $_________

­­­­­­­­­­­­­­­­­­­­­­­­­              ALL PAYMENTS ARE NON-REFUNDABLE. THIS IS A BINDING AGREEMENT FOR THE TERM OF THE                  SESSION/SEASON}

           Dual Release of Liability Waiver:

             Name of child participant (if under 18: ____________________________________

              Name of adult participant / parent: ______________________________________  

               I / we, despite all reasonable precautions implemented for safety, am / are fully aware of and appreciate the risks,  

               including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated  

               with participation in the programs or activities.  I / we knowingly and willingly assume all such risks.  

               Consequently, I / we hereby for myself, heirs, executors & administrators, do waive and release any and all rights  

               and claims for damages against the owner, operators, coaches, and other members of H.H. Island Gymnastics (the   

               releasee) from personal injury or accident of any sort or nature suffered by me (us), The undersigned, by reason of 

               participation or membership in classes, lessons, or any programs or activities of H.H. Island Gymnastics.

             Participant signature (if over 18) or Name of Parent/guardian__________________________

            Minor’s Release

           I, the minor’s parent and/or guardian understand the nature of these activities and the minor’s experience and  

              capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in

              such activities. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless  

              each of the releasee’s from all liability claims, demands, losses, or damages on the minor’s account, including  

              negligent rescue operations. I further agree that if, despite this release, I the minor, or anyone on the minor’s behalf

              makes a claim against any of the releasee’s named above. I will indemnify, save and hold harmless each of the  

              releasees from any  litigation expenses, attorney fees, loss liability, damage, or cost you may incur as the result of  

              any such claim.

                    _________________________________                          ____________

                           Signature of Parent or Guardian                                                  Date

                                                                      Permission of Treatment

              I hereby give my permission to trained medical professionals to administer Emergency Medical treatment

                to my child, should sickness or accident occur in my absence.

                                                                                         Signature_______________________________

ALL FEES ARE NON-REFUNDABLE

Hilton Head Island Gymnastics

(843) 815-6590     379 Browns Cove Rd.   Ridgeland, SC 29936

hhigym@hargray,com  or  website: hhigymnastics.com