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REGISTRATION FORM

Participant’s Name _______________________________________________________ Phone ___________________

Street ____________________________________ City __________________________ Zip ______________________

Age _________________ Birthdate ____________________   male   female

parent/Guardian Name(s) ___________________________________________________________________________

Email ______________________________________________________________________________________________

class or camp choice ________________________________________________ day __________ time _________

number of hours per week __________________  Monthly OR SESSION FEE ____________________________

 

 
 

PAYMENT POLICIES

YOU WILL NOT BE INVOICED. Session fees are due in full at the time of registration. Monthly payments are due the first class of each month. Payments not received by the 10th will be assessed a late fee. If payment is not received by the 15th of the month your child will not be allowed to attend class until payment has been received. If there is a problem with timely payments, please call to make special arrangements. The full monthly payment is due — there is no pro-rating for missed classes. If classes are missed due to illness or conflicts, please call the gym to schedule make-ups.

CLASS REGISTRATIONS: We have reserved a spot for your child in their class. You must notify the office by the 15th of the month if your child will not be continuing instruction for the next month.

PAYMENT METHODS: Payment can be made with cash, check, money order or credit card (MasterCard and Visa only). ALL CASH PAYMENTS MUST BE MADE TO THE FRONT DESK ATTENDANT AND RECEIPT ISSUED. Non-cash payments can be put in envelopes and put in the payment box located at the front desk. Make all checks payable to CHAMPIONS FOR LIFE. We can bill your credit card automatically for monthly payments (ask for details). There is a $20.00 fee for returned checks.

RELEASE

By their very nature, sports or activities such as gymnastics, martial arts, soccer, tennis or any other activity that involves motion carry a risk of physical injury. No matter how careful the athlete and instructor are, the risk cannot be eliminated. Potential injuries range from minor injuries, such as bruises to more serious injuries such as broken bones, dislocations and muscle pulls, to catastrophic injuries such as permanent paralysis or even death from landings or falls on the back, neck or head. Participation in these activities carries with it a reasonable assumption of risk. By signing this release, I hereby for myself, my children adopted or otherwise, my heirs and executors, waive and release any and all rights against Champions For Life, their agents or representatives; for any injury or damages that may be suffered by me, my children adopted or otherwise, in connection with my association or entry in gymnastics, martial arts, soccer, tennis or other activities sponsored by Champions For Life.

In case of emergency, contact _____________________________________________

Phone _____________________________________________

Relationship _____________________________________________
.
Check here if there are any medical concerns we should be aware of and please note them on the back of this form.

Parent/Guardian Signature _____________________________________________ Date______________________

How did you hear of us? (Please check one)
Friend      Citizen      Radio      TV      Other ____________________________

FOR OFFICE USE ONLY
Attendance __________ Bookkeeping __________