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Flip Flop Shop Enrollment FormGymnastics, Dance, Cheer
NAME OF STUDENT: ____________________________________ AGE _________ BIRTHDATE ______________
Parents (guardians): ___________________________________Phone________________________________ Address:_____________________________________CITY: ___________________ ZIP: _________________ CLASS(ES): __________________________________ TIME(S): _____________ DAY(S): __________________ ENROLLMENT FEE PAID: ____$25 _____ TUITION E-MAIL: __________________________________________ PHONE: _________________ CELL: ___________ EMERGENCY CONTACTS (IN CASE PARENTS CANNOT BE REACHED): __________________________________________________________________________________________ DOCTOR OR HEALTH FACILITY THAT SHOULD BE CONTACTED IN CASE OF INJURY: __________________________________________________________________________________________ DOCTOR: ____________________________________________ HEALTH FACILITY & PHONE: ______________ ----------------------------------------------------------------------------------------------------------------------------------------------- TUITION AGREEMENT The Flip Flop Shop requires a two-week WRITTEN notice prior to dropping. This written notice must be received by the third week of the session the student is currently enrolled. I understand I am responsible for a full session of payment for the month(s) that I fail to give written notice. Tuition payment is due prior to the beginning of the first class of the session. There is a drop-box in the lobby or payments may be mailed to: JoAnne Thaw 313 Witmarsum West North Newton, Ks. 67117
AFTER THE FIRST CLASS, A $5.00 LATE FEE WILL BE ASSESSED. I FULLY UNDERSTAND THIS POLICY. SIGNATURE: _____________________________________________ DATE: __________________________ ----------------------------------------------------------------------------------------------------- Warning agreement to obey instructions and assumption of risk
(Both the gymnast and parent or guardian MUST read carefully and sign) I am aware that gymnastics can be a dangerous activity involving MANY RISKS OF INJURY. I understand that the dangers and risks of participating or competing in gymnastics include, but are not limited to: bumps, bruises, scratches, broken bones, strains, cuts requiring stitches, serious injury to the joints, ligaments, muscles, tendons and other aspects of the muscular skeletal system; serious head and neck injuries which may result in complete or partial paralysis: brain damage; serious injury to virtually all muscular parts and serious injury or impairment to other aspects of my body, general health and well-being.
I understand that the dangers and risks of participating in gymnastics may result not only in serious injury, but in serious impairment of my future physical and mental abilities. Because of the dangers of participating in gymnastics, I recognize the importance of following coaches' instructions regarding skill techniques and gym rules and agree to obey such instruction. In consideration of your acceptance of my entrance into your program, I hereby assume all the risk associated with participation. I, intending to be legally bound, do hereby, for myself, my heirs, executors, and administrators, waive release and forever discharge all right and claims against the Gymnastics Fun & Fitness Center, LLC "Flip Flop Shop" and or any involved personnel for damage or injury sustained by me in practice, for travel to and from or participation in classes, work-outs, clinics and meets. Signature of Gymnast: ____________________________________________________________________ Signature of Parent or Guardian ____________________________________________________________ Doctor or health facility that should be contacted in case of injury: _______________________________ |