Gymnastic World of Fort Myers

BIRTHDAY PARTIES & OPEN GYM

RELEASE/CONSENT FORM

 

 

 

Gymnastic World of Fort Myers, it’s coaches and other staff members, do not accept and will not be held responsible for injuries sustained by any member, student or visitor during the course of gymnastics, tumbling, dance or cheerleading instruction, open gym times, birthday parties, lockins, camps or in the course of any exhibition, competition or clinic in which she/he may participate or while traveling to or from any event. With the above in mind and being fully aware of the risks and possibility of injury involved, I _______________________________, as parent/legal guardian of the below named child(ren), consent to have my child(ren) participate in the programs offered by Gymnastic World of Fort Myers. I further agree that I, my executors or other representatives, hereby waive, hold harmless and fully release all rights and claims for damages that I or my child(ren) may have against Gymnastic World of Fort Myers, and/or its representatives whether paid or volunteer.

 

Child’s First and Last Name_________________          DOB__________ 

Street Address City State Zip _____________________________________

Parent/Legal Guardian Full Name_________________________________ 

Parent/Legal Guardian Signature__________________________________ 

Cell Phone Number____________Work/Day Phone Number____________

15989 Old US 41

Fort Myers, FL  33912

Phone:  239.482.4440

gymnasticworldflorida@yahoo.com

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