Release Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#006633" TEXT="#F7F7FF" background="040d6c00ddvuru.jpg"> <div> <IMG SRC="048a94b0.png" border=0 width="169" height="75" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> Release Form</div> <div> <A HREF="index.htm" TARGET="_top" TITLE="Team Central Gymnastic Academy"><U>Team Central Gymnastic Academy</U></A> </div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="About Us"><U>About Us</U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Location"><U>Location</U></A></div> <div> <A HREF="id220.htm" TARGET="_top" TITLE="St. Louis Classic Gymnastics Meet"><U>St. Louis Classic Gymnastics Meet</U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A></div> <div> <A HREF="id30.htm" TARGET="_top" TITLE="Girls Team Program"><U>Girl's Team Program</U></A></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="Cardinal Power Kids Gymnastics"><U>Cardinal  Power Kids  Gymnastics</U></A></div> <div> <A HREF="id49.htm" TARGET="_top" TITLE="Special Events Programs"><U>Special Events & Programs</U></A></div> <div> <A HREF="id55.htm" TARGET="_top" TITLE="School Schedule of Classes"><U>School Schedule of Classes</U></A></div> <div> <A HREF="id359.htm" TARGET="_top" TITLE="2006 Summer Schedule of Classes"><U>Summer Schedule of Classes </U></A></div> <div> <FONT SIZE="1" COLOR="#FFFFFF" FACE="Arial Black" >     </FONT>     <A HREF="id57.htm" TARGET="_top" TITLE="St. Louis Classic Sponsors"><U>   St. Louis Classic & Team Central Sponsors</U></A></div> <bR> </td> <td valign="top" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -     </B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>Team Central Gymnastic Academy Release Form</B></div> <bR> <div> <B>                                                                          </B></div> <div> <B>Print Parent/ Guardian Name:_____________________________________________________________________________</B></div> <div> <B>Child's Name:___________________________________________________________________________________________ </B></div> <div> <B>Age:______ DOB ___/___/___ </B></div> <div> <B>Address__________________________________________ City:__________________________ State:________ Zip:_______ </B></div> <div> <B>Phone: (Day) (____) _______________ (Eve) (_____) __________________ </B></div> <div> <B>Emergency Phone: (____) ____________________ </B></div> <bR> <div> <B>Medical or Physical Concerns: ____________________________________________ </B></div> <div> <B>I understand that in gymnastics, like other sports that involve activity, there is a possibility of injury. An injury may be anything from a bruise, a broken bone, or a permanent disability (possibly paralysis) or even death. We take special steps to assure safety in the gym. Proper mats, equipment and progressive skills assure reasonable safety. It does not assure that the children will not be injured. I hereby consent to have my child/ward participate in programs offered by Team Central Gymnastic Academy. It is agreed that I, my child(ren) adopted or otherwise, my executors, waive and release all rights and claims for damages that I may have at any time against Team Central Gymnastic Academy its representatives whether paid or volunteer for any injury or damages in connection with the gymnastics program or other activities related to gymnastics. The risks involved in respect to such a program are fully understood. </B></div> <div> <B>PERMISSION FOR MEDICAL TREATMENT: I confirm that the above named person is in good health. I hereby authorize simple first aid and consent to any x-ray, exam, and medical or surgical diagnosis, which are deemed necessary. </B></div> <bR> <div> <B>Signature:______________________________________ Date: ______/______/_____ </B></div> <bR> </td> </tr></table></body>