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How did you hear about us? *          * - denotes required fields
Registration Fee: *
Family Information:
Family Name:
Contact #1 First Name:* Last Name: * Type:*
Home Phone:* Cell #: Work #:
Email: (Emails are kept confidential)
 
Contact #2 First Name: Last Name: Type:
Home Phone: Cell #: Work #:
Email: (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Home Phone: *
Emergency Contact Info:
(Not Contact #1, Contact #2)
Health Insurance Carrier:
 
Student #1 Information:
Student's First Name: * Last Name: *
Student Gender:  Birth Date: * (format=mm/dd/yy) 
Student Email:
School: Grade Level:
Disabilites:
Allergies:
Medications:
Primary Doctor:
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Classes
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Enter Class #1 Day and Time: *
 
Student #2 Information:
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Student's First Name: * Last Name: *
Student Gender:  Birth Date: * (format=mm/dd/yy) 
Student Email:
School: Grade Level:
Disabilites:
Allergies:
Medications:
Primary Doctor:
View Class Schedule

Classes
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Enter Class #1 Day and Time: *
 
Student #3 Information:
Show/Hide Details
Student's First Name: * Last Name: *
Student Gender:  Birth Date: * (format=mm/dd/yy) 
Student Email:
School: Grade Level:
Disabilites:
Allergies:
Medications:
Primary Doctor:
View Class Schedule

Classes
Select Class #1: *
Enter Class #1 Day and Time: *
 
Student #4 Information:
Show/Hide Details
Student's First Name: * Last Name: *
Student Gender:  Birth Date: * (format=mm/dd/yy) 
Student Email:
School: Grade Level:
Disabilites:
Allergies:
Medications:
Primary Doctor:
View Class Schedule

Classes
Select Class #1: *
Enter Class #1 Day and Time: *
 
 
CAUTION: Any activity involving motion or height creates the possibility of serious injury, including permanent paralysis and even death from landing or falling on the head or neck.
Release of Liability
As legal guardian of the child registered on this form, I hereby consent for him/her to participate in gymnastics and fitness classes conducted by the Olympiad, Inc. I recognize that any activity involving height or motion can create the possibility of injury, I hereby forever release the Olympiad, Inc. officers, directors, and employees from all liability for any and all damages and injuries contracted with gymnastics, classes and/or camps. A service charge of 1 1/2% per month, 18% APR, will be added to all overdue accounts. Also liable for all legal and collection fees.
I've read the above and agree.
 
Signature Text
As the legal parent or guardian, I release and hold harmless Richmond Olympiad Gymnastics, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Richmond Olympiad Gymnastics, its owners and operators or in route to or from any of said premises.
I've read the above and agree.
 
 
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