1. sports
2. gymnastics

Please circle how long your child has been enrolled in our programs:
Athlete
0 - 6 months 1 2 3 4+ year
Last: _____________________________________________
First: ____________________________________________
D.O.B. : ______________________________ Gender: M / F
Parent/Guardian/Participant Consent to Participate & Waiver
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YYYY / MM / DD
Home Phone #:____________________________________
Address:____________________________________________________
___________________________________________________________
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_____________________________
City: ____________________ Postal Code: ______________
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Primary Contact- Parent / Guardian
Name: ___________________________________________
Cell #: ___________________________________________
Work Phone #: ______________________ext: ___________
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Email Address: ____________________________________
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Secondary Contact-Parent / Guardian / Grandparent /Other
Name: ___________________________________________
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Cell #: ___________________________________________
Work Phone #: _______________________ ext:__________
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Email Address:_____________________________________
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Emergency Contact
Name: ___________________________________________
I warrant that the participant named on this form is
physically fit to participate in gymnastics.
I declare that I have accurately disclosed all information
regarding physical, mental or medical condition
affecting the named participant and acknowledge that
this information may be used for the Club and/or
Gymnastics Ontario use in the delivery of a gymnastics
program.
I acknowledge that there is potential risk for injury
involved in training and competition in any sport.
I understand that Gymnastics Ontario has tried to
create a safe and controlled environment for
participation and that the Club has established rules for
participation on and about the gymnastics area that
must be followed by the participant.
I understand that failure to comply with any of the
policies and rules of the Club and/or Gymnastics
Ontario may result in the suspension or termination of
membership.
I waive the rights of the participant to damages or other
costs, in the event injury is caused due to participation
in gymnastics or other involvement with the Federation.
I hereby give permission for emergency medical
treatment to be administered to my son/daughter/self,
as may be determined by reasonable discretion of
his/her/my coach/manager.
It is understood that whenever reasonably possible,
relatives will be contacted and informed of the
problem, diagnosis and/or treatment required and
anticipated medical results.
I understand that it is my responsibility to ensure that
the information on this form is kept current and I will
notify the Club of any changes immediately.
I understand that any pictures, film/video may be used
for publicity, promotion or any marketing of GymZone
and hereby waive compensation or claim of any kind
thereto.
I hereby give permission to GymZone to contact me and
send electronic messages through e-mail and forms of
social media knowing I can unsubscribe at anytime.
Phone #: _________________________________________
Signature of Participant
Special Medical Notes:
____________________________________________________
___________________________________________________________
___________________________________________________________
Date:________________________________________________
___________________________________________________________
Parent/Guardian if Participant is Under 18 years of age
*We provide a Peanut-Safe environment!
Fall
Class:
Day:
Time:
am/pm Coach:____________
Winter Class:
Day:
Time:
am/pm Coach:____________
Spring Class:
Day:
Time:
am/pm Coach:____________
Class List
** T.O.P StarZ Program is Invitation ONLY! **
55 Minute Classes
45 Minute Class
- Twinkle TotZ (18-36 months)
- Mommy & Me Fitness
1 Hour 25 Minute Class
- Twinkle ToddlerZ (3 Yrs Old)
- Flip StarZ (6 – 9 Yrs Old)
- KinderStarZ / KinderStarZ PLUS!(4 & 5 Yrs Old)
- Top StarZ (6 - 7 Yrs Old)
- Rising StarZ/Future StarZ (6+ Yrs Old)
1 Hour 55 Minute Class
- All StarZ – Boys (6+ Yrs Old)
- Super NovaZ (8 – 12 Yrs Old)
- Shooting StarZ – Trampoline (6+ Yrs Old)
- Competitive High School Prep
- T.O.P StarZ (5 Yrs Old)
3 Hour 50 Minute Class
- Super NovaZ – Boys (6+ Yrs Old)
- T.O.P StarZ (8 - 12 Yrs Old)
- Super NovaZ – Trampoline (6+ Yrs Old)
- Adult Gymnastics
For Office Use Only
Class Fees are subject to H.S.T
GymZone is a proud member of Gymnastics Ontario
All participants are required to pay a $25.00 annual fee
**Fall Session 2014: *September 8th, 2014 to November 29th 2014 (12 Weeks)
Payment Method:
Cash
Debit
Visa
Mastercard
Balance:
Receipt #: _________
Gymnastics Ontario Fee: ______
**Winter Session 2014 *December 1st, 2014 to March 14th, 2015 (12 Weeks)
Payment Method:
Cash
Debit
Visa
Mastercard
Balance:
Receipt #: _________
Gymnastics Ontario Fee: ______
**Spring Session 2015 *March 23rd, 2015 to June 13th, 2015 (12 Weeks)
Payment Method:
Cash
Receipt #: _________
Gymnastics Ontario Fee_____
Debit
Visa
Mastercard
Balance: