461 West Street, Amherst, MA 01002 (413)256-6990
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REGISTRATION FORM
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Student Name
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First
Last
Please enter the name that the student would like to be called. Example: enter Abby, instead of Abigail.
Student Preferred Pronouns
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he/she/they
Student Date of Birth
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mm/dd/yyyy
Age
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Parent 1 Name
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First
Last
Parent 1 Phone Number
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Email
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Parent 2 Name
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Parent 2 Phone Number
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Parent 2 Email
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Billing Address
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Line 1
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City
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Zip Code
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Emergency Contact Phone Number
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First Choice Day/Time
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See class schedule for day and times.
Second Choice Day/Time
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Summer Session
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Participant's medications/medical conditions/allergies:
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This information is kept confidential. The information is on file in case of emergency.
WAIVER, RELEASE AND CONSENT TO TREAT FORM
Hampshire Gymnastics Injury Waiver & General Release
During each new session, the instructors review the safety rules with the students. Please remind your child to follow the teacher’s instructions. Consistent disregard of safety rules may result in your child being asked to leave the class.
General Rules and Conduct during Class:
- There must be an instructor present in order to ENTER the gym and use the equipment.
- Absolutely no horseplay is permitted.
- Only one person is allowed on a piece of equipment at a time.
- Avoid following other students too closely.
- Be on time for class with proper attire and hair pulled back neatly.
- Ask the teacher to go to the rest rooms or to get a drink of water and walk around the edge of the gym.
- Do not run in front of others, across mats or stations.
Lobby and Outside Rules:
- No pets are allowed in the lobby at any time.
- Climbing the trees and going behind the bushes is prohibited.
- Absolutely no running or horseplay is allowed in the lobby.
- Touching/banging on the windows is not allowed.
- Students are to wait in the lobby to be picked up.
Special Equipment Precautions:
Bars
- Hanging on the cables or the metal support bars is not allowed.
- Swinging close to or touching the spin locks is not permitted.
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JUMPING from the LOW BAR to the HIGH BAR is NOT ALLOWED without an instructor present.
Beam
- Only bare feet are allowed on the beam.
- If you feel like you are falling, jump off to a SAFETY STOP landing.
- Look around before jumping off the beam (be aware of others).
Tumbling
- Keep eyes open, and keep a safe distance from other tumblers.
Trampoline/Pit/Airbag
- NEVER get on the trampoline without permission.
- Stay in the center of the trampoline bed at all times.
- LOOK before you jump in the pit/airbag! Land on your feet/bottom/back. NO DIVING or belly landings.
General Learning Safety Tips:
- Do not attempt a skill you have not been taught in class.
- If the instructor's directions are unclear, ask questions.
- Do not attempt a skill by yourself without the instructor’s permission.
Warning of Risk to Participant:
It is essential that you be in good health and in good physical condition to participate in gymnastics. If you have any physical ailments you should notify us immediately and bring written consent from your doctor stating that you are capable of safely participating in class.
Be advised that gymnastics is an activity involving motion and height; it will always contain the possibility of accidental injury/paralysis/loss of life. Even under close supervision by properly trained and qualified instructors using modern and safely designed equipment, the risk of injury can never be eliminated.
Checking "
I agree
" below indicates that:
I give permission for my child’s/children’s participation in Hampshire Gymnastics’ programs/activities.
I understand and agree to comply with the rules stated above.
I am aware of the risk inherent in participating in gymnastics.
I authorize Hampshire Gymnastics School to provide customary medical assistance, transportation, and emergency medical services, if required, while participating in activities at Hampshire Gymnastics School.
I have reviewed my child’s contact information with the office and have at least two current phone numbers where I can be reached in case of an emergency.
I will allow my child’s/children’s image to be used by Hampshire Gymnastics School, Inc. in advertising, marketing and promotional materials including, but not limited to, website photos/videos, online social media platforms, brochures, newsletters, bulletin boards, etc.
I agree to release, discharge, indemnify and hold harmless Hampshire Gymnastics School, Inc., its employees, officers or agents from any liability, loss or damages resulting from injury or loss to my child or myself.
I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage, which I consider adequate for the participant's protection. This consent shall remain effective until one year from the date below unless sooner revoked in writing and delivered to Hampshire Gymnastics School, Inc., 461 West St., Amherst, MA 01002.
My typed name and choice of 'I agree' indicates that I have read and understood this acknowledgement and assumption of risks, representation of ability to participate, release and indemnification. I understand that by electronically signing (clicking 'I agree') this document, I am giving up substantial rights. I am executing this document voluntarily and with full knowledge of its significance.
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