EARLY OUT REGISTRATION FORM

Student’s Name _________________________ Age ______ D.O.B. ___/___/___ Sex ___

Address _____________________________City ______________ Zip __________

Phone __________________  Cell Phone _________________  School _________________________

Mother/Guardian’s Name ______________    Father/Guardian’s Name _______________

Emergency Contact: ________________________________ Phone:_________________

Please list any medical conditions/allergies of  which we should be aware of : ________________________________________________________________________

As legal guardian of ______________________, I recognize that injuries can occur in any activity

 involving height or motion.  I voluntarily consent to the afortementioned person participating in Triad Gymnastics, L.C.’s activities and accept all risks associated with that participation. 

I give permission for Triad Kids Campus to take photographs of my child and have them used for

promotional purposes, have them printed in the newspaper, on television, on Triad’s website and in any flyers or brochures. 

__________________________________________                ______________

Parent or legal guardian’s signature Date