Gymnast Name:  ________________________________________

Competition Level:  ______________________________________

By completing this form, you are authorizing Kathi’s Dance & Gym Center to withdrawal your gymnast from the following meet(s):

MEET DESCRIPTION MEET DATE    REASON (injury, conflict, etc.)

____________________   ____________    __________________ 

____________________   ____________    __________________

____________________   ____________    __________________

Parent’s Name (print): ___________________________________

Parent’s Signature: ___________________________ Date:  ____________

Coach’s Signature: ___________________________  Date:  ____________