Athletic Arts Center

ONLINE REGISTRATION:


Last Name: 
First Name: 
Address 1: 
Address 2: 
City: 
State:  AL
Zip: 
Home Phone:
Cell Phone: 

e-mail Address: 


Age: 

If under 18, please complete the following:

Parent's Last Name: 
Parent's First Name: 
Work Phone: 
e-mail Address: 


Medical conditions or allergies to which we should be alerted?


I have read the Assumption of Risk - Waiver of Liability - Medical Authorization an do hereby agree to its terms and conditions:

Yes
No 
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I recognize that severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, those activities including but not limited to gymnastics, tumbling, trampoline, dance, and cheerleading.  Being fully aware of these dangers, I hereby give consent for my
child(ren) to participate in any and all Athletic Arts Center programs and activities and I ACCEPT ALL RISKS associated with this participation.