REGISTRATION CARD


 Childs Name __________________________________________________________    

 Birthdate: ___________________________________


 Phone: _________________________________ Date: ___________________________

 

 Address: ________________________________________________________________

 

 City: __________________________________ State: ________ Zip: _______________

 

 

 Mother’s Name: ___________________________ Wk Phone: ______________________

 

 Email Address:  ___________________________________________________________

 

 Father’s Name: ____________________________ Wk Phone: ______________________

 

 Email Address:  ___________________________________________________________

 

 Emergency Contact: __________________________ Phone: _______________________

 

 

 

                                                                                         

 

                                                                  WAIVER AND RELEASE

   General:  In consideration of allowing the below named student to enroll in a gymnastics school program and the use by the students of the

   premises and the property of said school, the undersigned, being the legal and acting guardians of the student, acting for themselves and on behalf of the    

  student release and hold harmless GYMagine Gymnastics, Inc., it’s owners, officers and employees of and from any and all 

   liability, claims, actions, and causes of actions whatsoever, arising out of or relating to any loss, damage, or injury, that may be sustained by the student   

  while in, on, or upon the premises of GYMagine Gymnastics Inc.  I also give my permission for my child to be photographed by 

   GYMagine Gymnastics employees to only be used in training or promotional materials for GYMagine Gymnastics.

   Medical Attention:  The undersigned, being duly aware of the risks and hazards inherent upon participation in the classes, activities, and events being   

  conducted by GYMagine Gymnastics Inc., acting for themselves and the student, hereby elect voluntarily to enter upon said premises under the control of   

  said corporation, knowing their present condition.  The undersigned acting for themselves and the student, hereby voluntarily assume all risks of loss,      

  damage or injury, that may be sustained by the student while in said premises described above.  In the event of any incident which may require immediate 

  medical/dental or any other emergency attention/care, in which the Legal Guardian cannot be notified in a reasonable time through reasonable means, I

  hereby authorize GYMagine Gymnastics Inc. to take all necessary actions as it relates to immediate medical/training attention, transportation, and

  emergency medical services as warranted in the course of care of the Undersigned student.,  I realize that I will be responsible for all fees and expense as they

  may relate to this medical attention paragraph.

  Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other   

  damages and losses associated with participation in a gymnastics event.  I further agree that GYMagine Gymnastics Inc. along with its employees, agent,   

  officers, and directors shall not be liable for any losses, expenses, or damages occurring as a result of my participation in the class, activities, or event except

  where such loss or damage is the result of the intentional or reckless conduct of one of the groups or Individuals identified above.

  Acknowledgement: This release shall be the binding upon distributes, heirs, next of kin, executors, and administrators of the student and the undersigned.

          In signing this release, the undersigned hereby acknowledges:

          a).  That he or she has read this release, understands it and signs it voluntarily.

          b).  That the undersigned signing as legal guardians are true legal guardians.

 

 
  STUDENT NAME: ______________________________________________ DATE: ___________________________

 

LEGAL GUARDIAN SIGNATURE: ____________________________________________________________________

 

             GYMagine Gymnastics Concussion Information Sheet

 

A concussion is a brain injury and all brain injuries are serious.  They are caused by a bump, blow, or jolt to the head, or by a blow to

another part of the body with the force transmitted to the head.. They can range from mild to severe and can disrupt the way the brain

normally works.

Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged

brain damage and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. 

You can’t see a concussion and most sports concussions occur without loss of consciousness.  Signs and symptoms of concussion may

show up right after the injury or can take hours or days to fully appear.  If your child reports any symptoms of concussion, or if you notice

the symptoms or signs of concussion yourself, seek medical attention right away.

 

Symptoms may include one or more of the following:

•Headaches                                                                         •”Don’t feel right”

•”Pressure in head”                                                             •Fatigue or low energy

•Nausea or vomiting                                                          •Sadness

•Neck pain                                                                           •Nervousness or anxiety

•Balance problems or dizziness                                       •Irritability

•Blurred, double, or fuzzy vision                                     •More emotional

•Sensitivity to light or noise                                               •Confusion

•Feeling sluggish or slowed down                                     •Concentration or memory problems

•Feeling foggy or groggy                                                    (forgetting name of skills)

•Drowsiness                                                                          •Repeating the same question/comment

•Change in sleep patterns

•Amnesia

 

Signs observed by teammates, parents and coaches include:

•Appears dazed                                                   •Slurred speech

•Vacant facial expression                                 •Shows behavior or personality changes

•Confused about assignment                           •Can’t recall events prior to hit

•Forgets plays                                                      •Can’t recall events after hit

•Is unsure of game, score, or opponent          •Seizures or convulsions

•Moves clumsily or displays no                       •Any change in typical behavior or

  coordination                                                        personality

•Answers questions slowly                                •Loses conciousness

 

What can happen if my child keeps on playing with a concussion or returns too soon?

Athletes with the signs and symptoms of concussion should be removed from play immediately.  Continuing toplay with the signs and

symptoms of a concussion leaves the young athlete especially vulnerable to greater injury.

There is an increased risk of significant damage from a concussion for a period of time after the concussion occurs,particularly if the

athlete suffers another concussion before completely recovering from the first one.  This can lead to prolonged recovery, or even to severe

brain swelling (second impact syndrome) with devastating and even fatal consequences.  It is well know that adolescent or teenage athletes

will often under report symptoms of injuries.  And concussions are no different.  As a result, education of administratiors, coaches, parents

and students is the key student-athlete safety.

 

If you think your child has suffered a concussion

Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately.  No athlete may return to

activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. 

Close observation of the athlete should continue for several hours. The new “Zachery Lystedt Law” in Washington now requires the consistent

and uniform implementation of long and well-established return to play concussion guidelines that have been recommended for several years:

 

“a youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be romoved from competition at that time”

and “may not return to play until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussion

and received written clearance to return to play from that health care provider”.

 

 

                                              Please read and return the bottom portion to GYMagine Gymnastics

 

 

You should also inform your child’s coach if you think that your child may have a concussion.  Remember, it is better to miss one game than to

Miss the whole season.  When in doubt, the athlete sits out.

 

 

________________________________________                                                   ________________________________________                   _______________

Student-Athlete Name Printed                                                                                          Student-Athlete Signature                                                                  Date

 

 

________________________________________                                                   ________________________________________                   _______________

Parent/Legal Guardian Name Printed                                                                             Parent/Legal Guardian Signature                                                     Date