Elite Gymnastics, Inc.

FUN-TAZ-TICS Registration Form

AUGUST 2002 - JULY 2003

Student's Name:
Age: Birthday: Grade:
Child's school:
Parent's Name:
Address:
City: Zip:
Phone (home): DRIVER'S LICENSE #:
Work phone (mother): Work phone (father):
Cell phone: Beeper:
E-MAIL ADDRESS:   Please do not e-mail me
Health Insurance: Policy #:

I hereby understand that I am responsible for the above registered child's camp tuition which is to be paid when services are rendered. If tuition is not paid by the end of the month, I understand I will be assessed with a $5.00 per month late charge. I also understand there will be a $20.00 charge for any NSF checks.We, the undersigned, parents or legal guardians, of the Applicant whose name appears above, recognize that there is a substantial risk of injury arising from the applicant's participation in the programs of Elite Gymnastics, Inc. therefore in consideration of such applicant's participation in the instructional and recreational programs of Elite Gymnastics, Inc. do hereby agree to indemnify and hold harmless the said Elite Gymnastics, Inc. it's officers, instructors, employees and representatives from any and all liability, loss or damage, including reasonable attorney's resulting from claims causes of action, demands, costs of judgements against the said Elite Gymnastics, Inc. it's officers, instructors, without limitation, any injury, illness or accident, to such Applicants, arising from such Applicant's participation in any way, in any program, course of instruction or travel with the said Elite Gymnastics, Inc. We further expressely give a member of the staff of Elite Gymnastics, Inc the power to consent to medical treatment during an emergency situation for health and safety of my child in the event I/We cannot immediately be contacted.

Date: this _____ of ______________, 200__       
   

Signature of Parent / Guardian

 

THANK YOU FOR CHOOSING ELITE GYMNASTICS!

 

OFFICE ONLY:

REGISTRATION FEE:
Computer: BASE CHARGE:
Roster: PRORATED:
Book: AGE GROUP:
Personnel: DAY: TIME: