CLASS REGISTRATION FORM

DOWNLOAD PDF AT BOTTOM OF PAGE 

2018-2019

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 2019 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

 

Ċ
Jeff Pomeroy,
Jun 18, 2018, 12:49 PM
Comments