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Samtastic Gymnastics
INFORMATION AND PERMISSION SLIP

START DATE: ________________________________________
CHILD'S NAME:

________________________________________
PARENT'S NAME:

________________________________________
ADDRESS: ________________________________________
  ________________________________________
  ________________________________________
TELEPHONE
NUMBERS:


Mom's Home: _________________________________
             Work: __________________________________
 

Dad's Home: __________________________________

            Work: ___________________________________
Days and time attending:


_______________________________________________________

_______________________________________________________
   
Name of room or Latchkey:

_______________________________________________________
   
Gymnastics
Experience:

_______________________________________________________
   

Additional Comments:

(please note any health conditions)

_______________________________________________________

_______________________________________________________

_______________________________________________________
   
Parent Signature:

Please make checks payable to Samtastic Gymnastics, Inc.
You will be informed of the day and time your child is taking class.

As with any physical activity, I understand there exist a risk of injury.  On behalf of my child, i consent to him/her attending class at Samtastic Gymnastics, Inc.

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