OFFICE	REGISTRATION FEE	1ST CHILD'S TUITION	2ND CHILD'S TUITION	CHECK # & AMOUNT
USE ONLY

Siouxland Gymnastics Academy Registration Form

Student’s last name________________________________________ Home phone ( )________________________

Email address_____________________________________________ Cell phone (_______ )_________________________

First name________________________________ Class code________________ Birthdate___/___/___ Age _____ M/F

First name________________________________ Class code________________ Birthdate___/___/___ Age _____ M/F

First name________________________________ Class code________________ Birthdate___/___/___ Age _____ M/F

Street_____________________________________________ City_____________________________Zip_______________

Father_____________________________Employer/Position___________________________ Wk phn________________

Mother____________________________ Employer/Position___________________________ Wk phn________________

Emergency (other than parents) __________________________________ Relationship_____________ Phn____________

Medical considerations___________________________How did you hear about us?_______________________________

In consideration of my membership in Siouxland Gymnastics Academy, and my participation in Siouxland Gymnastics (SGA) classes, events, competitions and activities, I agree to be bound by each of the following:

1. Eligibility: I agree to comply with the rules of Siouxland Gymnastics Academy.
2. Readiness to Participate: I will only participate in the SGA classes, events, competitions and activities for which I believe that I am physically and psychologically prepared. Prior to participation, I will have practiced my exercises and will perform only those exercises which I have accomplished to the degree of confidence necessary to assure I can perform them by myself, and without injury.
3. Medical Attention: I hereby give my consent to SGA to provide, through a medical staff of its choice, customary medical attention, transportation, and emergency medical services as warranted in the course of my participation.
4. Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated with participation in gymnastics activities and events. I further agree that SGA, and the sponsor of any SGA event, along with the employees, agents, officers, and directors of these organizations shall not be liable for any losses or damages occurring as a result of my participation in the event, except where such loss or damage is the result of the intentional or reckless conduct of one of the organizations or individuals identified above.

I understand that my child (children) is automatically enrolled. If my child (children)

discontinues participation in class, I will inform SGA in writing at least two weeks prior

to the drop. Failure to notify will result in continued tuition payments. Tuition is due for

the entire month in which a drop occurs and I will be charged accordingly. Initials______

I understand that there is a non-refundable yearly registration fee. This fee is payable upon initial registration and annually thereafter. Tuition is due on or before the first day of each month. A $5.00 late fee will be applied to any unpaid account after the first day of the month. No refunds will be given for inclement weather. Gum chewing and jewelry are prohibited in the gym. Appropriate clothing must be worn. Leotards with no skirting, buttons or zippers are required for girls. Long hair must be tied back off of the face. Boys should wear shirts tucked in and shorts free of zippers and snaps.

This notification of risk and enrollment has been read thoroughly, is understood completely and has been discussed with my child. It is being signed voluntarily and I acknowledge its content and intent.

Parent’s signature______________________________________________ SS #__________________________________

Date_____________________________