“A Night at the Oscars”

TeamGym Competition

Saturday, February 6, 2010

Location:

10556 Industrial Ave.Roseville, CA95678

Registration Fees:

$45 TeamGym Competitors ($55 if after December 1st)

$10 Double Dippers

$7 Spectator Admission (5 & under Free)

Deadline:

December 1, 2009

Please feel free to contact us with any further questions:

(916) 772-3547- Please ask for Erica

“A Night at the Oscars” Entry Form Saturday, February 6, 2010

Club Name______USAG Club #______

Address:______

City:______State______Zip:______

Contact Person’s Name:______Coach (if different)______

Gym: (___)___-____ Fax: (___)___-____ Cell: (___)___-____

E-mail:______

Fee / Quantity / Total
TeamGym Participants / $45
TeamGym Double Dips (Competing on more than 1 team) / $10

Grand Total______

THERE IS A $7 ENTRY FEE FOR SPECTATORS!

Please fill out and mail the following information no later than December 1, 2009

We look forward to seeing you!

Please feel free to contact us with any further questions at: (916)772-3547-Please ask for Erica

Please do not send a check for each family- Submit ONE check per club!

Please make checks payable to: Flip-2-It Sports Center 10556 Industrial Ave. Roseville, CA95678

TEAM GYM

Club Name______

Club #______

Team Name / # of Athletes / # of Females / # of Males / Level
  • This is a sanctioned meet.
  • Boys and co-ed teams will be competing by level only. There will be no separation.

COACHES

Coach Name / USAG # / Membership Exp. Date / Safety Certification Date

Equipment you plan to bring:______

Please do not send a check for each family- Submit ONE check per club!

Please make checks payable to: Flip-2-It Sports Center 10556 Industrial Ave. Roseville, CA95747

Team Gym Athletes

Gymnast Name / USAG # / Release Form / Level / Team Name / Total Due
1
2
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5
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StudentInformation

10556IndustrialAve.,Ste130

Roseville,CA.95765

ChildName: Sex: Age: D.O.B. ChildName: Sex: Age: D.O.B. Address: City: Zip:

HomePh.: ()

Mom'sName: Mom'sC#: () Dad'sName: Dad'sC#: ( )

Mom'sEmail:

Dad'sEmail:

Arethereanymedicalconditionstowhichweshouldbealerted? Howdidyouhearaboutus?(ifwordofmouth,fromwhom?)

Hasanyoneinyourfamilypreviousleybeenenrolledwithus?

YesNo

Ifyes,approx.date/yr.

T/OClassDate

CoachDay

Time

Payment/ClassInformation

AnnualFamilyAdministrationFee:$ Tuition(per4weeksession.fullpaymentrequiredtoreservespot)$ TotalFees:(firstsession) $

$

T/OClassDateTotal:$ CoachDay

Time

Program:Class:Day:Time: Program:Class: Day: Time: Program: Class: Day: Time:

AssumptionofRisk*WaiverofLiability*PhotoRelease*MedicalAuthorization

Iamawarethereareinherentrisksforpotentiallysevereinjuriesincludingpermanentparalysisordeathwheninvolvedinsportsoractivitiesinvolvingheightandmotion includingbutnotlimitedtogymnastics,tumbling,trampoline,martialarts,dance,team,campsoranyotheractivityatFlip2ItSportsCenter.Beingfullyawareofthese dangers,I voluntarilyconsentonbehalfofmyselfandmychild(ren)totheparticipationinanyandallFlip2ItSportsCenterprograms,camps,classesandactivities I ACCEPTALLRISKSassociatedwiththeparticipation.

ONBEHALFOFMYSELFANDMYCHILD(REN),IACCEPTALLSUCHRISKSANDPROMISENOTTOSUE, ANDFOREVERRELEASE,JTSSportsServices, Inc. dbaFlip2 ItSportsCenter,eachof theirrespectiveofficers,directors,shareholders,employees,contractors,invitees,licenseesandagents("you")fromallliability fordamagesorinjuriesincurredasaresultof participationbymychild(ren)ormyself.Thisincludesthoseinjuriesresultingfromactsof negligencebyyou.Ialsowaive allrightsanythird partymayotherwisehaveto pursuea claimagainstyouonmybehalf(includingtherightsto subrogation).If,despitethisagreement,Ioranythird partyonmybehalfmakesaclaimagainstyou,I willdefend,holdharmlessandreimburseyouforsuchclaimandliabilitiesincurredasaresultofsuchclaim.

In theeventof anaccidentoremergencyIAUTHORIZEMYCHILD(REN)TOBETRANSPORTEDTOAMEDICALFACILITYFORTREATMENT,atmycost,and willholdyouharmlessinyourmanagementofsuchaccidentoremergency.Iagreetoprovideforallmedicalexpenseswhichmaybeincurredbymyselformychild(ren) asaresultofanyinjurywhileonyourpremisesorwhileunderyourcare.

I amawarethatphotosandvideosaretakenfromtimetotimeformarketingandinstructionalpurposesandI herebyconsenttotheirusebyyou. I havereadandunderstandthisAssumptionofRisk,WaiverofLiability,PhotoReleaseandMedicalAuthorization.

Parent/LegalGuardianSignature

Date