First Name:______________________ Middle: ______________________ Last:___________________

Street:_________________________________ Apt #:____City:___________________ Zip:__________

The above address belongs to: Parents ___  Mother ___ Father ___  Other ____________

Date of birth:___/___/___  Age:___  Grade :________________________________________________

Mother’s Name:________________________  Home Phone:_____________ Cell:_______________

Father’s Name:_________________________ Home Phone:_____________  Cell:_______________

If the above child lives with a legal guardian (other than parents) please fill below.

Name:_____________________ Relation:________________ Home:____________ Cell:___________

Emergency Contact: (Please list someone other than parents)

Name:_____________________ Relation:________________ Home:____________ Cell:___________

Please list any medical conditions, or concerns, that may affect your child’s participation, as well any medications your child may be taking: ___________________________________________________________________________________________

1st  Class: ___________________________ Day & Time:_________________ Class Fee:  $______

2nd Class: ___________________________ Day & Time:_________________ Class Fee:  $______

Camps you are attending:  Week #1___  #2___ #3___ #4___              Camp Fee: $______

Registration Fees: Sep-Aug $35, Dec-Aug $26.25, Mar-Aug $17.50, May-Aug $8.75 Registration Fee: $  _____

Total: $_______

THIS FOLLOWING STATEMENT MUST BE READ BEFORE SIGNING    

I fully understand that C. Natalie Stanley’s Tumble Town Gymnastics, Inc., hitherto, CNSTTG, staff members are not physicians or medical practitioners of any kind.  With the above in mind, I hereby release CNSTTG’s staff to render temporary first aid to my child, or children, in the event of any injury or illness, and if deemed necessary, by CNSTTG’s staff to call our doctor, and to seek medical help, including transportation by a CNSTTG staff member, and or its’ representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the CNSTTG staff deem it necessary.  We, the staff of CNSTTG recognize our obligation to make our students and their parents aware of the risks and hazards 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 to injury!  Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and coaches instructions.  The CNSTTG, its’ coaches and other staff members, will not accept responsibility for injuries sustained by any student during the course of gymnastics, tumbling, dance or cheerleading instruction, open workouts, in the course of any exhibition, competition, camp, event or clinic in which he or she may participate or while traveling to or from the event.  With the above in mind, and being fully aware of the risk and possibility of injury involved, I consent to have my children or children participate in the programs offered by CNSTTG and or its representatives whether paid or volunteer.  I also affirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage which I consider adequate for both my child’s protection and my own.  I also understand that it is the parents or legal guardian’s responsibility to warn the child about the dangers of injury.  The parent should warn the child according to what the parent feels is appropriate.   CNSTTG will only warn the child through “Safety Message” and our teaching style and progressions.  By signing this, you agree to the above, our payment policies for the time period your child participates in our program offerings.

Parent or Legal Guardian Signature:__________________________________Date:____________

MUST BE SIGNED BEFORE PARTICIPATION WITHOUT EXCEPTION

 

IF YOU WANT TO SIGN UP FOR AUTOMATIC WITHDRAW, AND SAVE $5.00 EVERY MONTH OFF OF CLASS TUITION, FILL IN THE FOLLOWING INFORMATION.

 

Nine digit routing number: ___ ___ ___ ___ ___ ___ ___ ___ ___

Checking account number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___


I give permission for the monthly payments to be withdrawn  from my bank account for the time period I specify. 

Signature:_________________________________ 

 

Those paying for classes by automatic withdraw, need only enclose a voided check. 

All others enclose full payment for class and registration fees to secure a place in class or camp.

Tumble Town Gymnastics
Registration Form