Please contact the gym prior to mailing waivers and registration forms to
ensure availability of classes!
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ALL THAT CHEER & TUMBLE REGISTRATION FORM
Please include $30 annual
Class Description:__________________________registration fee if required
M F
Child’s Name (First, Last) Date of Birth Sex
Parent’s/Guardian’s Name Primary Emergency Contact Name (if same write same)
([ ]) ([ ]) ([ ]) ([ ])
Home Phone Work Phone Home Phone Work Phone
( ) ( )
Cell Phone Cell Phone
Address Alternative Emergency Contact Name
___________________________
Email____________________________
(_______)____________ (______)________________
Home Phone Work Phone
(_______)_____________________________________
Cell Phone Relationship
Medical Information
Physician’s Name:
Phone#________________________________________
Insurance Co: Policy#
Allergies/Special Health Considerations:
______________________________________________________________________________________________
______________________________
I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital
procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive
my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be
reached in the case of an emergency.
Parent’s/Guardian’s Signature Date
Media Release ________ Check if permission denied
I give permission for my child to be included in any media releases of All That Cheer and Tumble. Such use includes
the display, distribution, publication, transmission or otherwise use of photographs, images, and/or video taken of my
child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters,
videos and digital images
Parent’s/Guardian’s Signature Date
PLEASE COMPLETE PAGE 2, WAIVER OF LIABILITY FORM >>