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:________