Turtles Gymnastics Guest Registration Form

Registration Form

Turle’s American Gymnastics & Trampoline Academy Inc.

1960 Enterprise Pkwy Twinsburg OH 44087

330 – 405 – 0777   www.americangymnasticsacademy.com   fax 330 – 405 - 0771

Student’s Name Sex D.O.B Age

Home Address City Zip

Home Phone Daytime email(parent)

Driver’s license OR Social Security # required

Father’s Name Social Security # Driver’s License#

Place of Employment Occupation

Work Number Cell Phone Number

Driver’s license OR Social Security # required

Mother’s Name Social Security # Driver’s License#

Place of Employment Occupation

Work Number Cell Phone Number

In Case of Emergency please list an alternative contact should we be unable to reach you.

1. Emergency Contact Relationship Phone

2. Emergency Contact Relationship Phone

Please list any medical conditions and/or allergies we should be aware of

Child’s Doctor Phone

I/We hereby give my/our authorizations to contact my/our child’s doctor and/or transport my/our child to a nearby medical facility for treatment by medical personnel after reasonable effort to contact me/us.

First Choice: Class Day Time

Second Choice: Class Day Time

Registration/Insurance Fee: (Non-Refundable)

$40 per year per family

Class Fees

Total Fees Due

(NO REFUNDS)

AUTOCHARGE

To have your monthly tuition conveniently charged to your credit card each month, please fill out the following information.

Card Type Card Number Exp. Date

Visa/Mastercard/Discover

Automatic Charge Amount $ Charge Dates Signature

I/WE Initials hereby agree to pay $ per month for Initials

I do understand and agree to pay the monthly tuition regardless of my child’s attendance until a written withdrawal notice is submitted to Turle’s office.

Person responsible for billing:

Please select:

Tuition will be charge the 15TH OF THE MONTH PRIOR     Tuition will be charged on the 1st

Monthly Rates

45 min. $44    3hr $125

1hr. $55    4hr. $140

2hr $100    6 hr. $170

Payments made after the 8th of the month will be assessed a $10 LATE CHARGE. Early Payment Discount of $5 off /child/month– available for AUTOCHARGE customers ONLY – payments made on the 15th of the month prior

Turle’s Gymnastics Rules and Policies

In consideration of membership as a student athlete at Turle’s Gymnastics, the parents and/or legal guardian are aware of and agree to the following:

Please initial next to each statement that you have read, understand and agree

MINOR RELEASE AND WAIVER OF LIABILITY AND INDEMMITY AGREEMENT WITH ACKNOWLEDGEMENT OF RISK

1. The participant will be instructed in and shall carefully follow all gymnastics safety guidelines and rules as posted, as instructed and as demonstrated by Turle’s American Gymnastics and Trampoline Academy, Inc.

2. I/We realize that gymnastics carries a risk of physical injury, including serious injury, paralysis, or death.

3. I/We hereby accept and assume such risks and responsibilities for the losses and/or damages following such injury, disability, paralysis or death.

4. The “Releasees” are: Turle’s American Gymnastics & Trampoline Academy, Inc.; Event Hosts; Other participants; Coaches; Instructors; Officials; Sponsors; Advertisers; Owners; Lessees of the premises.

5. I/We also affirm that I/we now have and will continue to provide proper hospitalization, health, and accident insurance coverage.

6. I/We give permission for Turle’s American Gymnastics and Trampoline Academy, Inc. to publish gymnastics class pictures of my child without compensation.

CLASS ENROLLMENT AND PAYMENT POLICIES

1. Tuition is due monthly prior to the 1st class of each month and late payments after the 8th incur a $10 late charge.

2. Once registered into a monthly program, my child’s spot will not be surrendered unless a WRITTEN WITHDRAWAL NOTIFICATION FORM is submitted by the 15th of the month prior to withdrawal.

3. All classes are paid monthly and NO REFUNDS are given for any reason.

I/We have read the above waiver and release, and understand that I/we give up substantial right by signing it without inducement.

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (“AGREEMENT”)

In consideration of participating in instruction at Turle’s American Gymnastics and Trampoline Academy Inc., I represent that I understand the nature of this activity and that I am qualified, in good health, in a proper physical condition to participate in such an activity.

I fully understand that this activity involves risks of serious bodily injury, including permanent disability, paralysis and death.

I hereby release, discharge, and covenant not to sue Turle’s American Gymnastics and Trampoline Academy Inc., its respective administrators, directors, agents, officers, volunteers, employees, sponsors, and others from liability, claims, damages, or losses arising from participation.

I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, and understand that I have given up substantial rights by signing it.

PARENTAL CONSENT

AND I, the minor’s parent and/or legal guardian, understand the nature of the above referenced activities and the Minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the “Releasees” from liability, claims, demands, losses or damages arising from the minor’s participation.

I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the “Releasees” from any litigation expenses, attorney fees, loss liability, damage, or cost any “Releasees” may incur as a result of any such claim.