Meadowlark Sports, Inc
dba Helena Kidsports, Mount Helena Gymnastics and Air Jam Inflatables
5 Wall Street, Montana City, MT 59634
Mother’s Name: __________________________________________________________________
Father’s Name: ___________________________________________________________________
Address: ___________________________ City: ____________________ Zip Code: ___________
Mother’s Cell/Home: ______________________ Father’s Cell/Home: _______________________
Mother’s Work Phone: ____________________ Father’s Work Phone: ______________________
Emergency Contact Name: __________________________ Phone: _________________________
Email Address: ________________________________ Occupation: ________________________
Student First Name
Student Last Name
Birth Date
M/F
Class Type
Day
Time
Start Date
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Medical Information (Please provide specific information to any health problems or disorders that may affect your child’s
participation at Helena Kidsports.)
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Doctor: ____________________________________________ Dentist: _______________________________________________
Insurance: _________________________________________________________________________________________________
Waiver
I am aware that participation in this sport will be a dangerous activity involving many risks of injury or death. I
understand the dangers and risk of participation include, but are not limited to, death, serious neck or spinal injury, brain
damage, serious injury to all internal organs, injury to all bones, ligaments, muscles, tendons and all other aspects of the
body. I understand the dangers and risks of playing or practicing may result not only in serious injury, but in serious
impairment of future ability to earn a living, engage in business and generally enjoy life.
Because of the dangers of the sport, I understand the importance of following the coaches’ instruction
regarding technique, training and other rules, and agree to obey instruction.
In consideration for allowing me to participate, I hereby assume all risks associated with the sport and agree to
hold Helena Kidsports, its employees and agent, harmless from any and all liability, causes of action, debts, claims or
demands of any nature whatsoever that may arise in connection with my participation in any activities related to the
sport. The terms hereof serve as a release and assumption of risk for my heirs, estate, and for all members of my family.
I, as the legal parent of guardian, have read the above warning and release and understand its terms. I
understand this sport involves many risks including but not limited to those stated above.
In consideration for Helena Kidsports permitting my child to participate in its program, I hereby agree to hold
Helena Kidsports, its employees and agents harmless from any liability which may arise in connection with
participation of my child in activities related to them.
Parents: If you are not readily available in the event of an injury to your child we need your permission to
contact appropriate medical services.
I grant permission to the instructors of Helena Kidsports to seek appropriate medical attention for my child if they are
injured. I understand that attempts to contact will also be made.
Parent/Guardian: ______________________________________ Date: ______________________
I also understand the tuition policy in effect, which requires that tuition be paid by the 15 th of the prior month. If tuition
is not paid by the 20th of the prior month, a $20 late fee will be applied to my account. If tuition is not paid by the 25 th of
the prior month, my child(ren) will be dropped from the class.
 I do not want Helena Kidsports to use my child’s picture in future gym advertisements to include the internet,
television commercials, or print advertisement.