Club Information
Club Name *
Short Name *
Club Booster Club Name
Club Email Address *
Password *
Should be 8 to 16 characters long and can be alphanumeric only.
Confirm Password *
Additional Email
Club Website *
Club Number *
Cell Number *
Physical Address
Street Address *
City *
State *
Zip *
Mailing Address (if different than physical address)
Street Address
City
State
Zip
Does your club use:
Club Owner Info
Legal First Name *
Preferred First Name *
Middle Name
Last Name *
Date of Birth *
Gender *
Residential Address *
Personal Email *
City *
State *
Zip *
Club Representative Information
NOTE THAT ONLY CLUB REPRESENTATIVES WILL HAVE ACCESS TO ALL ONLINE CLUB FUNCTIONS AND PROCESSES
Club Representative 1
Position/Job Title
Legal First Name
Preferred First Name
Middle Name
Last Name
Date of Birth
Gender
Residential Address
Personal Email
City
State
Zip
Club Representative 2
Position/Job Title
Legal First Name
Preferred First Name
Middle Name
Last Name
Date of Birth
Gender
Residential Address
Personal Email
City
State
Zip
Club Membership Agreement
    *Please initial after each paragraph of the agreement where indicated. Missing Initials/Signatures will result in additional processing time as we are unable to process incomplete applications. By signing below, I/we are agreeing to the terms listed as Club Membership Agreement, I agree that all requirements are in place at the time of applying and authorize National Gymnastics Association to process payment information listed below. Visit www.nationalgym.org/membership for more information.
    Initial:
  • I have full legal authority to sign for Club membership and understand and agree to accurately list the athlete and Competitive/Rookie Coaches information directly from Coach/Athlete applications and agree to keep these applications on file at Club at all times. NGA reserves the right to conduct audits and request copies of these applications if needed.
    • Initial:
  • I have/will visually witness and enter valid expiration dates for each Competitive/Rookie Coach(es) certification and acknowledge the certification requirements are valid through July 31, 2023. The requirements for Competitive Coaches (18 years and older) as specified are approved NCSI background check, Sports Engine Abuse Prevention Training Certification and Concussion Prevention Training Course completion. Rookie Coaches (16-17 years) are required to complete the Concussion Prevention Training Course only and have a signed application with signed guardian waiver/release.
    • Initial:
  • I understand that falsifying information for club, coach or athlete may result in immediate termination of club, coach or athlete’s membership and no refund(s) will be issued.
    • Initial:
  • I understand and agree to not be affiliated in any way with anyone on a banned list from any sport or is known to be on any sex offenders list or allow access/entry to the gymnastics club listed above.
    • Initial:
  • I acknowledge that I will receive and accept the Athlete application(s) from the designated Parent(s) and/or Guardian(s). I understand that no athlete may compete on the floor of an NGA sanctioned event until the requirements of a signed Parent/Guardian Application has been received by this Gym Club and athlete membership fee has been processed by Gym.
    • Initial:
  • I further agree to follow the U.S .Center for Safe Sport rules and policies, and understand that any employee, volunteer or adult of the age of 18 years of age or older who comes into regular contact or has authority over minor athletes/coaches in my gymnastics facility MUST complete the required Sports Engine Abuse Prevention Course. Visit www.nationalgym.org for more information on the Abuse Prevention Course.
    • Initial:
  • I agree to maintain current general liability and participant accident insurance that offers secondary medical coverage for any athlete or coach who is an NGA member of this gymnastics club through the membership period, and should any cancellation/change to this policy occur, club agrees to notify NGA within 72 hours by email: info@nationalgym.org. NGA reserves the right to request a copy of said insurance policy upon request.
    • Initial:
  • I understand that at any time during the membership term with NGA that membership may be revoked due to failure to maintain above requirements, including but not limited to intently falsifying information for any Coach/Club/Athlete/Representative listed under this club membership, failure to follow the U.S. Center for Safe Sport Guidelines, knowingly allowing ineligible Coaches on the floor of a NGA event, unethical practices regarding the safety of athletes and/or failure to uphold any terms of membership . Membership fees are non-refundable.
Owner/Managing Director Name or Person of Legal Authority to Accept the above terms:
Name: Title: Date:
Club Name: City: State:
Payment Information $225 Application Fee

*Fees are not prorated. Fees are non-refundable and non-transferable

Fee includes membership for (1) Gymnastics Club and all Competitive Coaches/Rookie Coaches

Billing Info
Card Holder Name *
Card Holder Billing Address *
Email Address *
City *
State *
Zip *
Phone *
Card Details
Card No *
Expiry Date *
(Format -mm/yyyy, ie: 01/2021)
CVC *
Signature *