Gymnastics School Name       

USAG Club #      

Street address      

City        State       Zip      

Coach/Owners Name      

USAG #      

Phone – Home   (     )      -     Work (     )      -         Cell (     )      -     

E-mail      

Damage to gym building      

Property damage      

Gymnastics Equipment damage      

Assessed amount of damage      

How much will insurance pay?      

What other monetary assistance have you applied for      

What other monetary assistance have you received?      

List your needs in order of what you feel in most important at the present time:

1)       

2)       

3)       

What are your other needs?      

Number of competitive gymnasts before hurricane      

Number of competitive gymnast after hurricane      

Number of recreational gymnasts before hurricane      

Number of recreational gymnasts after hurricane       

Number of employees before hurricane      

Number of employees after hurricane       

Are there any special needs of your employees?      

Are there gymnasts with hardship cases in your gym?      

What date did you or do you plan to reopen?      

 

Please return this form with pictures of damage form the street, two angles, including signage if possible.  Also send photos from four inside corners of the gym.  Label them N, S, E and W and from all 4 corners of lobby area, offices and any other rooms inside your gym.

Also include a letter from insurance agent characterizing extent of damage.

Mail to:  Debby Kornegay, 394 Stonebridge Road, Birmingham, AL 35210

E-mail to DebGK@Bellsouth.net