GymAble Registration Pack.

Please complete all sections.

Nadia Gym GymAble Registration

Gymnasts Name

First Name

Last Name

Date Of Birth

Note American format.

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian Contact Details

First Name

Last Name

Phone

(###)

###

####

Email

Parent / Guardian Contact Details

First Name

Last Name

Phone

(###)

###

####

Email

Attendance Day And Time

• Please seek medical clearance if your child has Down syndrome, Spinal Cord Injury, Spinal Fusion, Spinal Stenosis, Dwarfism or any other condition which may increase the risk of injury due to the nature of gymnastic activities.

• I have received medical clearance for my child to attend gymnastics

Yes

• Gymnastics Ireland requires that any member or participant with Down syndrome must provide medical evidence establishing the absence of Atlantoaxial Instability (AAI) before he/she may participate in any gymnastic-related activity.

• This screening must be undertaken by an appropriately qualified medical professional or chartered physiotherapist

• Please return the Screening form with this registration

Participation Agreement

• I understand there is an inherent risk of injury in gymnastic activities and that although the club will endeavour to minimise any risk, accidents may still happen. • I agree that my child must abide by the safety rules and codes of conduct at all times.

• I the parent /guardian will ensure that my child does not attend gymnastics if she is physically or medically unfit.

I agree

Parent / Guardian Consent ( under 18's)

I agree to my child/dependant participating in gymnastics and am fully aware of the risks involved in this sport.

First Name

Last Name

Todays Date

* Note American Format

MM

DD

YYYY

Medical History

Medical information provided will be treated as private and confidential.

GYMNASTICS IRELAND - Persons with Down syndrome

Approval for participation in gymnastics and trampoline gymnastics.

A qualified medical practitioner or chartered physiotherapist must complete tests outlined on form.

Please click here to download form