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So, you have a trampoline at home. Do you know how to use it properly? This clinic will teach you all you need to know about trampoline use and safety to avoid injuries at home. You will learn the basic rules of trampoline use and valuable safety tips to keep in mind when you’re “playing” on that trampoline! Don't have a trampoline at home? No worries! This clinic is also a great way to keep you safe wherever you decide to "play" on a trampoline. Recommended for ages 5-12 years old. Space is limited! Sign up early!

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	First Name:*	Last Name: *
	Type*
	Home Phone:*	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info*

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	School:	Grade Level:
	List any known allergies/allergic reactions::
	List any Medications::
	Primary Doctor's Name & Phone # & Date of Last Exam:*
	List any previous surgeries:
	List any previous broken bones:
	List any other health concerns:

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