Miss Chari’s Gym
Students Name______________________AGE____ Birthdate_______
Address:_______________________ City_________ Zip________
Mother’s Name ____________________Cell Phone #_____________
Father’s Name ____________________Cell Phone # _____________
ALLERGIES/MedicalConditions_____________________________
CLASS:_________________ DAY:_________ TIME: __________
LIABILITY WAIVER:
I acknowledge that any program such as /GYMNASTICS/Cheer Which involves movement and motion which can result in physical injury. I permit my child to participate and release Charisse Gardner from all liability for injury to my child from his/her participation in this program.
PARENT OR LEGAL GUARDIAN SIGNATURE:
X____________________________________________DATE:________