STUDENT
*Student's Name:________________________________________________
*Age:________________     *Birthday:_______________
Student's Email Address (optional):_________________________________

PARENTS
*Parents' Names:________________________________________________
*Address:_____________________________________________________
____________________________________________________________
*Parents Email Address:__________________________________________

PHONE
*Home:__________ *Work:__________ *Cell:__________ Other:__________

LEGAL GUARDIAN
(If other than parent.)
*Legal Guardian:________________________________________________
*Address Legal Guardian:_________________________________________
_____________________________________________________________
*Phone Legal Guardian:___________________________________________
*Email Legal Guardian:____________________________________________

Other Emergency contact Information?
_____________________________________________________________

SPECIAL CONDITIONS
List any special medical conditions or physical disabilities which might limit
your gymnast's or dancer's activity:__________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

*Parents Signature:_____________________________*Date:__________