Tumb2023-24 School YearleTownGymnasticsRegistratoinForm
TFirst Name:___________________ Middle: ____________________ Last: ____________________Date of Birth: ___/___/___ Current Age: ____ Medical Concerns: _____________________umbleAddress: _________________________Apt #: ___ City: __________ State: ___ Zip: __________The above address belongs to: Mother ___ Father ___ Legal Guardian ___ Other _______________TowMother's Name:___________________ Cell: ____________________ Home: ____________________Mother's Email:________________________ Contact 1st: __ Contact 2nd: __ Do not contact: __nGymnastFather's Name:___________________ Cell: ____________________ Home: ____________________Father's Email:________________________ Contact 1st: __ Contact 2nd: __ Do not contact: __Legal Guardian:___________________ Cell: ____________________ Home: ____________________Legal Guardian's Email:________________________ Contact 1st: __ Contact 2nd: __icsDO NOT LIST A PARENT'S NAME AS EMERGENCY CONTACT. THIS NUMBER IS FOR WHEN A CHILD IS NOT PICKED UP AFTER 15 MINUTES AND A PARENT IS NOT ABLE TO BE REACHED DUE TO AN UNFORSEEN EVENT.Emergency Contact:___________________ Relation To Child: ____________________ Phone: ____________________THE FOLLOWING STATEMEMENT MUST BE READ BEFORE SIGNING:I fully understand that Natalie Stanley's Tumble Town Gymnastics, Inc., hitherto, NSTTG, staff membersare not physicians or mecial practioners of any kind. With the above in mind, I hereby release NSTTG'sstaff to render temporary first aid to my child in the event of any injury or illness and if deemed necessary byNSTTG's staff to call a doctor and to seek mecial help, including transportation by a NSTTG staffmember, and or its' representatives, whether paid or volunteer, to any health care facility or hospital, orthe calling of an ambulance for said child, should the NSTTG staff deem it necessary. We, the staff of NSTTG recongnize our obligation to make our students and their parents aware of the risks andharzards associated with the sport of gymnastics, tumbling, cheerleading and dance. Students may suffer injuries,possibly minor, serious, or catastrophic in nature. Gymnastics, tumbling and cheerleading can be dangerous and lead toinjury! Parents hsould make their children aware of the possiblity of injury and encourage their children to followall the safety rules and coaches instructions. NSTTG, it's coaches and other staff members will not accpet responsibility for injuriessustained by any studnet during the course of gymnastics, tumbling, dance or cheerleading instruction, open workouts,in the course of any exhibition, competition, camp, event or clinicin which he or she may participate or whiletraveling to or from an event. With the above in mind, and being fully aware of the risk and possibilityof injury invloved, I consent to have my child participate in the programs offer by NSTTG and assume the risksand agree to hold NSTTG, it's representatives, whether paid or volunteer harmless. I also affirm thatI now have and will continue to provide proper hospitalization, health and accident insurancecoverage which I consider adequate for both my child's protection and my own. I also understand2023-24 Student Registration Fee $35Pee Wee Gymnastics $100 per month/$50 for siblings or additional classesTue 5:30-6:30 PM __ Thu 4:30-5:30 PM __ Sat 10:00-11:00 AM __Summer Class Offering For July/August: Tue 5:30-6:30 PM ONLY __that it is the parents, or legal guardian's responsibility to warn the child about the dangersof injury. The parent should warn the child according to waht the parent feels is appropriate.NSTTG will only warn the child through "Safety Message", our teaching style and progressions. By signingyou agree to the above and our payment policies, rules and policies and refund policies for the time period your child participate in our programs offerings. Also by signing this agreement, you acknowledge the contagious natureof COVID-19 and voluntarily assume the health risks and agree to hold NSTTG harmless.Beginner Gymnastics $100 per month/$50 for siblings or additional classesTue 6:30-7:30 PM __ Thu 5:30-6:30 PM __ Sat 11:00-12:00 PM __Summer Class Offering For July/August: Tue 6:30-7:30 PM ONLY __Advanced Gymnastics $115 per month/$57.50 for siblings or additional classesTue 4:00-5:30 PM __ Thu 6:30-8:00 PM __ Sat 12:00-1:30 PM __Summer Class Offering For July/August: Tue 4:00-5:30 PM ONLY __Top Tots Pre-Team $135 per month/$67.50 for siblings Wed 4:30-6:00 PM __ plus free unlimited additional beginner or advanced classesSummer Class Offering For July/August: Wed 4:30-6:00 PM ONLY __All Star Gymnastics Team: $160 per month/$80 for siblingsMonday & Friday 4:30-6:00 PM __Summer Class Offering For July/August: Mon & Wed 4:30-6:00 PM ONLY __USAG Gymnastics Team$155 1 day per wk __ $190 2 days per wk __ $195 3 days per wk __Mon 6:00-8:00 PM __ Wed 6:00-8:00 PM __ Fri 6:00-8:00 PM __Summer Class Offering For July/August: Mon & Wed 6:00-8:00 PM ONLY __If you want to sign up for automatic withdraw and save $5.00 every month off of the class tuition, fill in the following information or just enclose a void check.Routing Number: __ __ __ __ __ __ __ __ __Checking Number: __ __ __ __ __ __ __ __ __ __ __ __ __I give permission for the monthly payments to be withdrawn from my bank account for the time period I specify:Sign Here:Print Here:Summer Gymnastics Camp 2023$225 per week. 50% off for additional siblings or 2nd camp in SAME month.Camp #1 Jul 10-14 ___ Camp #2 Jul 17-21 ___ Camp #3 Jul 31-Aug 4 ___ Camp #4 Aug 14-18 ___Must be signed by parent or legal guardian only: Sign here: __________________ Date: ____________