Athlete Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Parent 1 *

First Name

Last Name

Parent 2

First Name

Last Name

Phone 1 *

(###)

###

####

Phone 2

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please Read *

By submitting this form I certify that the above information is correct and grants permission to post photos of children on our website and social media without last names and publish photos in local newspapers. Tumbling programs have existed for years with few accidents and injuries, however parents and participants are hereby informed that injury minor or major could result from an accident while playing this sport. By submitting this form I authorize the coach, Sue Cornelison, and assistant coaches to act according to their best judgement in an emergency requiring medical attention. As parent or guardian, I hereby wave and release Sue Cornelison and all coaches and the owners of the gym, Bridgetown LLC. Lee and Sheila Kearney, and the above mentioned of all liability for any accident or injury that might occur to said child while participation in this sport. As parent or guardian, I acknowledge the risk and assume all responsibilities.

I have read and agree to the above information.