CopelandGymnastics

Serving Topeka for over 34 years!

Phone: (785) 273-8545
Registration Form
Copeland Gymnastics
5331 SW 22nd Pl. 
(785) 273-8545

Gymnast Information
First Name: *
Last Name: *
Date of Birth: *
Gender: 
Address: *
City: *
State: *
Zip Code: * (5 digits)
Mom's Information
Mom's Name:
Mom's Home Phone:
Mom's Work Phone:
Mom's Cell Phone:
Mom's Email:
Dad's Information
Dad's Name:
Dad's Home Phone:
Dad's Work Phone:
Dad's Cell Phone:
Dad's Email:
Additional Student Information
Previous training?
If yes, where at?:
If yes, for how long?:
 What are you interested in? Gymnastics
Tumble Only
Parent-Tot
When are you available for classes?
 Monday:
4:00 pm
4:30 pm
5:00 pm
5:30 pm
6:00 pm
6:30 pm
7:00 pm
7:30 pm
 Tuesday:                                         
                                        4:00 pm
                                        
4:30 pm
                                        5:00 pm
                                        
5:30 pm
                                        6:00 pm
                                        
6:30 pm
                                        7:00 pm
                                        7:30 pm
Wednesday: 

4:00 pm
4:30 pm
5:00 pm
5:30 pm
6:00 pm
6:30 pm
7:00 pm
7:30 pm
 Thursday:

10:00 am 4:00 pm
10:30 am 4:30 pm
11:00 am 5:00 pm
11:30 am 5:30 pm
12:00 n                 6:00 pm
12:30 pm 6:30 pm
7:00 pm
7:30 pm

Medical Waiver and Release Form

I fully understand that Copeland Gym staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the Copeland staff to call the doctor and to seek medical help, including transportation by a staff member and 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 Copeland staff deem this to be necessary.

We, the staff of Copeland Gymnastics, recognize our obligation to make our students and their parents aware of the risks and hazards associated with the sport of gymnastics, tumbling, cheerleading, and dance. Students may suffer injuries, possibly minor, serious, or catastrophic in nature. Gymnastics and tumbling can be dangerous and can lead to injury!

  1. Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and coaches' instructions.
    • There are risks and dangerous associated with participation in gymnastic events and activities including but not limited to those of bodily injury, partial and/or total disability, paralysis, and death.
    • The social and economic losses and/or damages, which could result from those risks and dangers described above, could be severe.
  2. I/We accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis, or death, however caused or aleged to be caused in whole or in part by the negligence of the clubs, other participants, coaches, instructors, officials, sponsors, advertisers, owners and lessees of the premises used to conduct the event or activity & each of them their officers, directors, agents, and employees.
  3. I/We accept that this consent and assumption of Risk Statement covers each and every event sponsored by Copeland Gymnastics and or it's staff.

I have read and agree to the above statement.
Type your name in box below for electronic signature.

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