BIG ROCK GYMNASTICS & DYNAMITE CHEER

Transcription

1 BIG ROCK GYMNASTICS & DYNAMITE CHEER Registration Form Please Print Clearly PERSONAL INFORMATION: Mailing Address City St Zip Both Parents Address: / Home Phone # Childs Cell # Childs Mothers Name Cell # Carrier Receive Text Mothers Employer Work Number Fathers Employer Cell # Carrier Receive Text Fathers Employer Work Number EMERGENCY CONTACT INFORMATION: Emergency Contact Phone ( ) Cell ( ) Insurance Company Policy# Subscribers Name Subscribers SSN Allergies Special Instructions WHAT ARE YOUR EXPECTATIONS FROM THIS GYM? Check all that apply! Self Esteem Coordination Exercise Competition Other (Specify): LIST ANY PREVIOUS EXPERIENCE: Where: WHY DID YOU LEAVE YOUR LAST GYM? WHAT IS THE BEST WAY TO CONTACT YOU? (IE. PHONE, ) HOW DID YOU HEAR ABOUT US? TUITION POLICY: in order to participate YOU MUST HAVE DIRECT DEPOSIT OR A CREDIT CARD on file. We will not bill this card unless you use option B to make monthly payments. We will charge your card during the second week of the month if payments have not been made by the first week. TUITION IS DUE THE FIRST WEEK OF THE MONTH. Please Check one of the following: A: Pay by AUTOMATIC DIRECT DEPOSIT for a 5% monthly discount B: Pay monthly tuition by check or cash no later than the first week of every month C: Pay by Automatic Credit Card during the first week of every month Card Holders Full Name: Address (if different) Credit Card Type (Visa, Master Card, Amex, Discover) CC #

2 Acknowledgment of Risks & Hazards, Liability Release & Agreement Not To Sue for: DYNAMITE CHEER & TUMLBING, LLC, DBA BIG ROCK GYMNASTICS. It s Owners, Officers, Directors and their Successors in Interest, Affiliates, Agents, Landowners, Contractors, Instructors/Coaches, Referees, Employees, Volunteers and Insurers (Collectively, the Releasees ) PLEASE READ CAREFULLY BEFORE SIGNING, THIS IS A LEGAL DOCUMENT Before being permitted to participate in gymnastics/cheerleading programs, please read the following and sign below agreeing to comply with this agreement. Acknowledgement of Risks & Hazards: 1. I the participant and/or we the parent(s) and/or legal guardians will instruct the minor participant that, prior to participating in the indicated gymnastics/cheerleading or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I/We understand and agree that, if at any time, the participant feels anything to be unsafe; I/we will immediately take all precautions to avoid the unsafe area and refuse to participate further. 2. I/We fully understand and acknowledge that: A. THE ACTIVITIES OF THE EVENT(s) ARE VERY DANGEROUS and involve the risk of serious injury to any and all body parts, partial and/or total disability, paralysis, death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES> Further I understand and accept that minor injuries may become life-threatening emergencies when far away from convenient facilities. B. These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including but not limited to the Releasees named above. I further understand there may be other risks not known to us or are not reasonably foreseeable at this time. C. The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe. 3. I/We here by freely and expressly accept and assume all risks and responsibility for any, losses and/or damages following such injury, disability, paralysis or death however caused and weather caused in whole or in part by the negligence of the Releasees named above. I agree to RELEASE, FOREVER DISCHARGE, INDEMNIFY, DEFEND AND HOLD HARMLESS the Releasees from any and all losses, damages, costs and attorney s fees resulting from any claims or suits for personal injury, death and/or property damage that may in any way arise out of my participation in these activities, related activities or use of the Releasees premises, equipment, or any equipment regardless of how or by whom or by what the personal injury, death and/or property damage was caused. As a condition of myself, or my child, being entitled to participate in the activities associated with DYNAMITE CHEER & TUMLBING, LLC, DBA BIG ROCK GYMNASTICS and being permitted to gain access to and use the facilities and premises, I hereby promise not to bring (on my behalf, on behalf of my child or otherwise) any claim against or sue RELEASEES. I hereby certify that I and/or my minor child are physically fit and have no medical conditions or allergies that affect the ability to participate in these activities. First Aid Release: I authorize Releasees to administer first aid as they deem necessary. I authorize transportation to a medical facility, at my expense, if deemed necessary by Releasees. I understand and accept that minor injuries may become life-threatening emergencies when far away from others or convenient facilities. Further, in the case of serious illness or injury, if I cannot be reached, I give permission for treatment, including medical and/or surgical care necessary for the well-being of myself or my child (hereafter, minor participant ) at my expense. I understand that Releasees will, to the best of their ability attempt to notify me as soon as possible in the event of an emergency. I agree that upon transporting myself or my minor participant, to any medical facility, clinic or hospital, the responsibility of the Releasees shall be totally fulfilled and the Releasees shall have no further responsibility. Photographic Release: I/We consent to the use by Releasees of any pictures (video and print) for commercial purposes, or otherwise, of me or my minor child in connection with the activities of the Releasees, without restriction as to frequency, duration or medium.

3 Payment Terms: All tuition is due on the first week of the new month. You agree to pay all tuition covering classes for which your child is enrolled. No credit will be given for missed classes or nonattendance, except in cases of prolonged injury or illness or call Kellie Buchanan for canceling class before they miss. Make-up classes may be possible, but must be completed within 30 days and are subject to availability, or in during open gym and must be approved before missing your class. Accounts not current by the 10th of month will be considered past due and will be billed on your credit card. We will attempt to contact prior to using the credit card but will make no promises that we can reach you before we apply payment. We accept direct deposit, cash, checks (made payable Dynamite Cheer or Big Rock Gymnastics), as well as MC or VISA, we also offer an automatic tuition payment plan. I HAVE CAREFULLY READ THIS IMPORTANT DOCUMENT AND, FULLY UNDERSTAND ITS CONTENTS, AND I UNDERSTAND THAT I AM RELEASING CERTAIN LEGAL RIGHTS THAT I (OR THE MINOR CHILD) OTHERWISE MAY HAVE, BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. (PLEASE WRITE LEGIBLY) For Children Minor Participant(s) Name(s)(Print): Parent/Guardian: Signature Date / / For Adults Participant Name: Age D.O.B. / / Signature Date / / FOR OFFICE USE: Received By / / / Staff Name Date Time Class Assigned: Day and time of class:

4 Big Rock Gymnastics & Dynamite Cheer RULES AND POLICIES WELCOME to Big Rock Gymnastics & Dynamite Cheer. We hope that your child will enjoy our program, have fun and at the same time discover the exciting world of Gymnastics and Power Tumbling. These sports build muscle, balance, flexibility, and most important, self esteem. When a child is involved in a healthy, athletic environment, he/she is learning motor development, interpersonal relationships skills, discipline, commitment, teamwork and leadership among many other things. As you can see these sports enhance many aspects of life. We are excited to have your child join our program! We promise to do our best to make sure your child has fun while learning these sports in a safe and nourishing environment. Below are our rules and policies that help us to be the best gym for you and your child. GYMNAST/TUMBLING WORKOUT APPAREL Workout apparel for the girls consists of a clean and neat gymnastics leotard or shorts and nice fitting shirts. Boys should wear clean T-shirts and shorts without zippers or belts. Jewelry constitutes a safety hazard and will not be allowed to be worn during there participation in class. Girls with long hair must wear it tied back in a pony-tail or in braids for safety and convenience. No gum or candy is allowed in the gym area. Tumblers-Fitted T-shirt and athletic shorts. Students should arrive to the gym 5 minutes before class begins. Do not drop your gymnast off earlier than 10 minutes before class, as this represents a supervision problem for the coaches and the management. Gymnasts are not allowed on the equipment before their class begins, or after their class ends. Students are also expected to leave the workout area immediately after class, and should be picked up within 15 minutes of class dismissal. SUPERVISION of NON-PARTICIPANTS and WATCHING RULES Children not participating must be responsibly supervised and seated in the viewing area. Please do not drop off nonparticipant children to watch their brother or sister participate in gymnastics. We encourage parents and visitors to observe their child s lesson only once a month. Classes are much easier to teach when the gym is not filled with too MANY observers. The gym is quieter, allowing for greater concentration and learning. Please DO NOT COACH from the sidelines. This puts unneeded pressure on the kids and causes distraction. Leave that for when you are home. TUITION, REGISTRATION, MISSED CLASSES Each participant must pay a $25.00 Registration fee before beginning any class. A $25.00 annual fee will then be charged at Fall Registration. Also, the registration form must be filled out and signed by a parent before the student will be allowed to participate. Tuition will be pro-rated, if applicable, for the initial enrollment month only. We do not prorate or credit missed classes. You may sign up for a make up class if contact your child s coach or Kellie before the missed class. Make ups must be done within two months of missed class. Direct Deposit & Credit Card Policy A. A direct deposit or credit card must be on file even if you pay by cash or check B. Tuition is not considered past due until after the first week of the month C. Pay by automatic direct deposit and receive a 5% discount D. Pay by automatic credit card E. Please know your rate and pay accordingly. You will be notified of any rate changes if they do occur. Monthly reminders will be ed. Thank you for allowing Big Rock to be gymnastics & Dynamite Cheer instructors and not bill collectors. STUDENT PLACEMENT AND ADVANCEMENTS Periodic class testing will take place in each class and advancements are done on an individual basis. Your student does not have to wait for the rest of the class to move up. Kellie along with your child s coach will come to you when we feel the child is ready to move up. It will be up to you to decide if he/she does in fact move up. OFFICE RECORDS It is the parent's responsibility to update the office records with current phone numbers, emergency contact information and new addresses. Website:

5 Direct Deposit Authorization I authorize DYNAMITE CHEER & BIG ROCK GYMNASTICS to send credit entries, as well as appropriate adjustments and debit entries, to my/our accounts as indicated below. Account #1 Account Type: Checking Savings Institution Name: Bank Routing #/ ABA #: Account#: Percentage to be deposited into this account: Account #2 Account Type: Checking Savings Institution Name: Bank Routing #/ ABA #: Account #: Percentage to be deposited into this account: Please attach a voided check for each account here SIGNATURE DATE PRINTED NAME