Miss Chari's

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:________