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2019-2020 POMEROY GYMNASTICS, INC. REGISTRATION FORM Students Name _______________________________________________________Sex________Age________Date of Birth___________/__________/__________ Address___________________________________________________________________________________________________________________________________ Street City State Zip Mothers Name______________________________________________________ Fathers Name_________________________________________________________ Home Phone #_________-_________-__________ Work Phone #__________-___________-__________ Cell Phone #__________-__________-____________ How did you hear about Pomeroy Gymnastics?______________________________________________________________________________________________ Emergency Phone Number and Contact __________-_________-_________ ___________________________________________________________________ Are there any medical conditions to which we should be alerted?____________________________________________________________________________ CLASS INFORMATION 1ST Class Choice Class __________ Day __________ Time __________ 2nd Class Choice Class __________ Day __________ Time __________ Registration Fee $__________ Tuition $__________ Total $__________ After March 31st 2020 the registration fee drops to half. Registration fee and tuition are non-refundable. All returned checks are subject to a $25.00 service charge.
ACKNOWLEDGMENT OF RISK AND WAIVER OF LIABILITY As legal guardian of ______________________________, I hereby consent to aforementioned person participating in Pomeroy Gymnastics, Inc.’s programs. I recognize the potential for injuries which may occur in any activity involving height or motion. I understand that it is the express intent of Pomeroy Gymnastics, Inc. to provide for the safety and protection of my child and, in consideration for allowing my child to use these facilities, I hereby forever release Pomeroy Gymnastics, Inc. or its employees. As legal guardian of the aforementioned person, I hereby agree to individually provide for the possible further medical expenses which may be incurred by my child as a result of any injury sustained while training at, or performing for Pomeroy Gymnastics, Inc. This acknowledgment of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent.
___________________________________________________________________ ________ ___________________________ Parent or Legal Guardian's Signature Date
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