I request that this application be accepted for my son or daughter:

________________________________________________________________
Enter student's name

to participate in gymnastics and/or dance at Quantum Gymnastics & Dance Academy.

I understand that dance, gymnastics, or any sport that involves inversion in the air includes a risk of serious injury, paralysis or death. I understand that Quantum Gymnastics, it's director, coaches and guest clinicians have professional coaching experience and that these persons take maximum precautions to ensure that all gymnasts and class participants are kept safe.

I hereby release Quantum Gymnastics, it's director, coaches or guest clinicians from responsibility for any injuries sustained by my child while attending classes in gymnastics or dance at Quantum Gymnastics, or while participating or performing in any productions, exhibitions, camps, clinics or workshops sponsored by Quantum Gymnastics.

Parent or Legal Guardian: ___________________________  Date:___________

I hereby agree that I have read each of the Safety Regulations of Quantum Gymnastics & Dance Academy and agree to abide by each and all of them.

Gymnast's Signature: _______________________________  Date:____________

I hereby declare that my gymnast (daughter, son or dependent) has read and agrees to abide
by each and all of the safety regulations set forth by Quantum Gymnastics & Dance Academy.

Parent's Signature:__________________________________ Date:____________