Parkettes On-Line: Clinic Registration Form

Release form: I hereby for myself, my children, adopted or otherwise, my heirs, and executors, waive and release any and all rights and claims against the Parkettes, their agents or representatives, for any injury or damages that may be suffered by me, my child, adopted or otherwise in connection with my association or entry in gymnastics or other activities sponsored by the Parkette National Gymnastics Training Center.

Please mail your payment to:
Parkettes
401 Martin Luther King
Allentown, PA 18102
Credit Card Payments Call: 610.433.0011

Parkette Holiday Clinic 2007 (use your browser print button to print this form for mailing purposes)
	Registration Form
All Fields Required	December 27th , 2007		Gymnast Fee: $90, or $80 if postmarked by Dec 1st - Coaches: $55
Your Name:	E-Mail:
Gymnast Name:	Gymnast's Age: Level:
Address:
City:	State: Zip:
Insurance Company :
Policy Number :		Date of Last Physical:
	PLEASE BE PREPARED TO PROVIDE YOUR INSURANCE CARD OR PHOTOCOPY
	*ALL PARTICIPANTS MUST HAVE THEIR OWN INSURANCE
Home Phone:
Emergency Phone:		School/Club:
*Release form:* I hereby for myself, my children, adopted or otherwise, my heirs, and executors, waive and release any and all rights and claims against the Parkettes, their agents or representatives, for any injury or damages that may be suffered by me, my child, adopted or otherwise in connection with my association or entry in gymnastics or other activities sponsored by the Parkette National Gymnastics Training Center. Please mail your payment to: Parkettes 401 Martin Luther King Allentown, PA 18102 Credit Card Payments Call: 610.433.0011