Medical Information/Athletic Waiver & Release Form

It is Tri-County Gymnastics & Cheer policy to require that each member fill out a Medical Information/Athletic Waiver & Release form. To save time your child’s first session, download the Medical Information / Athletic Waiver & Release form, fill it out, and bring the completed copy with you to the gym.

The information yow will need to submit upon registration includes:

  1. Two Emergency Contacts –  who should be called in case of an emergency including their:
    1. Name
    2. Relation
    3. Phone Number
    4. Alternate phone number
  2. Physician’s Contact Information including:
    1. Doctor’s Name
    2. Physician’s office address
    3. Phone number
  3. Medical Insurance Information including:
    1. Medical Insurance Company Name
    2. Group Number
    3. Phone number

We will also ask questions regarding background information including: Does your the member have…

  1. Previous gymnastics experience? (no/yes/brief description)
  2. Allergies or intolerance to food or medication? (no/yes/brief description)
  3. Medications currently being taken? (no/yes/brief description)
  4. Previous injuries or illnesses? (no/yes/brief description)
  5. Restrictions or special considerations? (no/yes/brief description)

We will then require a guardian’s name, signature and date indicating agreement with the following:

I fully understand that Tri-County Gymnastics staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the Tri-County Gymnastics staff to render first aid to my child in the event of any kind of injury or illness, and if deemed necessary by the Tri-County Gymnastics staff to call our doctor and ask to seek medical help, including transportation by a Tri-County Gymnastics staff member or its representatives, whether paid or volunteer, to any health care facility or hospital or the calling of an ambulance for said child should the Tri-County Gymnastics staffdeem this to be necessary.


We will also require a guardian’s name, signature and date indicating agreement with the following:

The staff of Tri-County Gymnastics recognizes its obligation to make students and their parents aware of the risks and hazards associated with the sport of gymnastics, trampoline, tumbling, cheerleading, and dance. Gymnastics, trampoline, tumbling, cheerleading, and dance can be dangerous and can lead to injury. Students may suffer injuries possibly minor, serious, or catastrophic in nature.

Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and the coaches’ instructions. Tri-County Gymnastics, its coaches, and other staff members will not accept responsibility for injuries sustained by any student during the course of gymnastics, trampoline, tumbling, cheerleading, or dance instruction or open workouts or in the case of any exhibition, competition, or clinic in which he or she may participate while traveling to or from the event. With the above in  mind, and being fully aware of the risks and possibility on injury, I consent to have my child or children participate in the programs offered by Tri-County Gymnastics. I, my executors, or other representatives, waive and release all rights and claims for damages that I or my child may have against Tri-County Gymnastics and/or its representatives whether paid or volunteer. I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage which I consider adequate for both my child’s protection and my own protection. I also understand that it is the parents’ responsibility to warn the child about the dangers of gymnastics and injury. The parent should warn the child according to what the parent feels is appropriate. Tri-County Gymnastics will only warn the child through “safety messages” and our teaching style and progressions.