{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fnil\fcharset0 Tunga;}} {\*\generator Msftedit 5.41.15.1515;}\viewkind4\uc1\pard\brdrl\brdrs\brdrw15\brsp80 \brdrt\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp80 \brdrb\brdrs\brdrw15\brsp20 \qc\ul\b\f0\fs24 Acknowledgement of Risk and Waiver of Liability\par \pard\brdrl\brdrs\brdrw15\brsp80 \brdrt\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp80 \brdrb\brdrs\brdrw15\brsp20 \ulnone\b0\fs20 American Gymnastics Academy (AGA) has excess accident \endash medical insurance coverage. AGA\rquote s group insurance is \ldblquote secondary excess coverage\rdblquote over any valid collectable coverage provided by the parent(s)/ legal guardian separate, personal or employee\rquote s dependent group insurance. \tab\ul\b\fs24 Permission Slip\par \pard\brdrl\brdrs\brdrw15\brsp80 \brdrt\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp80 \brdrb\brdrs\brdrw15\brsp20 \fi720\ulnone\b0\fs20 __________________________has my permission to attend American Gymnastics Academy (AGA).\par \pard\brdrl\brdrs\brdrw15\brsp80 \brdrt\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp80 \brdrb\brdrs\brdrw15\brsp20 (child\rquote s name) I confirm that my child is in good health and that he/she has passed a physical examination by a doctor in the past 6 months. I give my permission for AGA officials to call a doctor, or the person listed below, in the event of an emergency. I will in no way hold AGA, its officials or staff members, responsible for any possible illness, accident, or injury which might occur in class training. Nor will AGA be held responsible for any illness, accident, or injury that might occur traveling to and from the AGA facility. ____________________________________________________Parent / Legal Guardian Signature\par \ul\b\i AUTHORIZATION TO TREAT A MINOR\par \ulnone\b0\i0 As the undersigned parent/legal guardian of ________________________________________________, (childs name)\par A minor, I do hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff licensed under the provisions of the Medicine Practice Act, or a dentist licensed under the provisions of the Dental Practice Act, and on the staff of any acute general hospital holding a current license to operate a hospital from the State of California Department of Health. It is understood that this authorization is given in advance of any specific diagnosis, treatment of hospital care being required, but is given to provide authority ad power to render care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient (student), but that any of the above treatment will not be withheld if the undersigned cannot be reached. This authorization is given pursuant to the provisions of section 25.8 of the Civil code of California.\par Date of last Tetanus Toxoid Booster:____________List any restrictions of allergies:_________________\par \pard\brdrl\brdrs\brdrw15\brsp80 \brdrt\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp80 \brdrb\brdrs\brdrw15\brsp20 \fi720\i This consent shall remain in effect until it is revoked\i0 .\par \pard\brdrl\brdrs\brdrw15\brsp80 \brdrt\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp80 \brdrb\brdrs\brdrw15\brsp20 _________________________________________\tab\tab ________________________________\par \tab Signature of Parent/Legal Guardian\tab\tab\tab\tab\tab Date\par \pard\brdrl\brdrdb\brdrw30\brsp80 \brdrt\brdrdb\brdrw30\brsp160 \brdrr\brdrdb\brdrw30\brsp80 \brdrb\brdrdb\brdrw30\brsp20 \qc\ul\b\fs24 ENROLLMENT\ulnone\b0\par \pard\brdrl\brdrdb\brdrw30\brsp80 \brdrt\brdrdb\brdrw30\brsp160 \brdrr\brdrdb\brdrw30\brsp80 \brdrb\brdrdb\brdrw30\brsp20 \b\fs18 My child has completed his/her Complimentary class. I have received, read, understand and will comply with AGA Guidelines. I would like to enroll my child at American Gymnastics Academy.______________(initials)\par \pard\brdrl\brdrs\brdrw15\brsp80 \brdrt\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp80 \brdrb\brdrs\brdrw15\brsp20 \b0\fs20\par Start Date:\tab \tab\tab Start Class:\par \par \par Monthly/Pro-rated Fee: $ + Enrollment Fee: $45.00\tab\tab = Amount Due: $\par \par \par }