Please fill out a separate form for each child.
Please select which day:	____ June 25, 2010
	____ July 23, 2010
	____ August 13, 2010
Name	___________________________________
TCT Member?	Current _____   |   Returning _____   |   New _____
Address	_________________________________________
City	_________________________________________
State, Zip	_________________________________________
Home Phone:	_________________________________________
Contact Number	_________________________________________
Parents' name(s)	_________________________________________
Allergies	_________________________________________
Who will be picking up the child?	_________________________________________

Parent Permission:
______________________(child's name) has permission to participate in an open gym day class at Twin City Twisters Gymnastics. Warning: Serious injury may result from improper conduct of this activity. I have instructed my child to follow directions. I give permission to Twin City Twisters Gymnastics and/or an appropriate medical facility to make whatever emergency (e.g. first aid, disaster evacuation) measures as judged necessary for the care and protection of my child while under the supervision of Twin City Twisters Gymnastics. In case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency resource (police, Rescue Squad) deems it necessary. The child will be transported at my expense. It is understood that in some medical situations, the staff will need to contact the local emergency resource before the parent, child's physician, and/or other adult acting on a parent's behalf.
I fully disclaim, waive, and discharge Twin City Twisters Gymnastics, their instructors, and directors from all claims with regard to any personal injury that may be incurred by my child during this class/party. My child is in good physical health, and there are no medical conditions which would limit his/her participation in class. I also understand that adults are not allowed in the gym(s) unless accompanied by a TCT staff member and have signed a release. ADULTS ARE NEVER ALLOWED ON ANY EQUIPMENT.

Date _____________________

Signature (parent/guardian) _______________________________