GYMNAST INFORMATION & INDEMNITY FORM

Surname of Gymnast

Date of Birth

First Names of Gymnast

Age at 1st January

Name of School

Mother's Name

Cellphone

Home/ Work

Father's Name

Cellphone

Home / Work

I/we agree for our child to appear on Paragon's social media posts.

Person Responsible For Payment Of Fees

Name of Doctor

Doctors Cellphone

Medical Aid Name & Number

Allergies / Injuries

Parents agree that in the event of an emergency arising in terms of which the child will require urgent medical attention, the child may be taken to the nearest hospital, clinic or doctor at the discretion of the management or authorized member of staff. The parents undertake to accept full responsibility for any medical costs incurred in the event of such an emergency.

Has Your Child Done Gymnastics Before

Name of Previous Club

INDEMNITY

I have read, understand and will abide by the rules and conditions of enrolment at Paragon Gymnastics Club

I HAVE READ THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND IT'S TERMS, UNDERSTAND THAT I HAVE GIVEN UP RIGHTS BY SIGNING IT, AND IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. MY SIGNATURE OF CONSENT OCCURS IN THE FORM OF CLICKING "AGREE TO TERMS AND CONDITIONS"

READ CONDITIONS OF ENROLMENT AT PARAGON GYMNASTICS CLUB

Parent/Guardian of

Signature of Parent/Guardian

Date