Gymworks

Full Name of Gymnast

female
male

Date of Birth

Name of School

Mothers name

Mother's Cell Phone Number

Mother's Physical Address

Father's Name

Father's Cell Phone Number

Father's Physical Address if different to Mother

Person responsible for payment of fees

email address for invoices and correspondence

Who else can we contact in case of emergency ?

Contact number for emergency person

Relationship to gymnast

Has your child done gymnastics before?

Yes
No

If yes, name of previous club

I hereby agree to the following :

Fees are paid in advance by the 5th day of each term
One month's notice fully paid and in writing is required to terminate membership
Tuition fees and membership fees are non refundable
No credit can be given for missed classes unless due to serious injury or illness

INDEMNITY

Furthermore, I do hereby irrevocably indemnify Gymworks Gymnastics Club, Lisa Solomon, Natalie Allen, the Gauteng Gymnastics Association, the South African Gymnastics Federation, Paterson Park Recreation Centre and or any agents or officials of the said club, persons, association, federation or center against any claim for injury that may arise, with full knowledge of the risks inherent in this activity, and hereby waive any claim that may arise therefrom

I acknowledge all the above information to be true and correct

Date