Fri Open Gym TrialDate ______

College OpenGym Joined ______

PARTICIPANTS INFORMATION
1ST CHILD / DATE OF BIRTH (MM/DD/YYYY) / CURRENT SCHOOL/GRADE LEVEL (If Applicable)
2ND CHILD / DATE OF BIRTH (MM/DD/YYYY) / CURRENT SCHOOL/GRADE LEVEL (If Applicable)
3RD CHILD / DATE OF BIRTH (MM/DD/YYYY) / CURRENT SCHOOL/GRADE LEVEL (If Applicable)
STREET ADDRESS / CITY / STATE / ZIP CODE
HOME PHONE / REFERRED BY (Include parent and child’s name) or circle one of these choices:
website magazine email blast
attended a field trip attended a party
PARENT/GUARDIAN INFORMATION
MOTHER’S FULL NAME / CELL PHONE / WORK PHONE
FATHER’S FULL NAME / CELL PHONE / WORK PHONE
PARENTS EMAIL ADDRESS
EMERGENCY CONTACT IF PARENTS CANNOT BE REACHED / CELL PHONE / HOME PHONE / RELATIONSHIP TO PARTICIPANT
MEDICAL WAIVER/RELEASE OF RESPONSIBILITY
I hereby grant the permission necessary to allow the minor(s) listed above to participate in Double Down Athletics.I acknowledge, understand, and assume all risk involved in any activities on these premises, including but not limited to, gymnastics and/or cheerleading, martial arts, dance, tumbling classes, aerial arts, aerobics, conditioning/strength training and inflatable play. I further agree to hold harmless Double Down Athletics, the locations landlord, operators, and employees, from any and all claims, suits, losses or damages of any nature whatsoever, including but not limited to such claims that result from my child’s injury or death, whether it be accidental, as a result of negligence or otherwise, during or arising in any way from,but not limited to, gymnastics and/or cheerleading, martial arts, dance, tumbling classes, aerial arts, aerobics, conditioning/strength training and inflatable play. I fully understand that Double Down Athleticsand its staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release Double Down Athleticsstaff to render temporary first aid to my child or children in the event of injury or illness, and grant permission to licensed hospital and EMT staff to administer immediate medical treatment as deemed necessary to my child should he/she be injured during any event he or she is left in the care of Double Down Athleticsstaff. Further, I understand that I am responsible for payment of expenses incurred relating to my child’s medical treatment. Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and the coaches’ instructions. In signing, I affirm that I have read this form in its entirety and that I understand the nature of the sports of gymnastics and/or cheerleading, martial arts, dance, tumbling classes, aerial arts, aerobics, conditioning/strength training and inflatable play. I have also read the policies & procedures on the back and agree with its terms and conditions.
PARENT/GUARDIANS SIGNATURE / DATE / PARTICIPANT’S SIGNATURE (18 AND OVER) / DATE
INSURANCE INFORMATION
INSURANCE CARRIER / GROUP # / POLICY #
INSURANCE PHONE # / INSURANCE COMPANY ADDRESS
PLEASE LIST ANY ALLERGIES, PHYSICAL OR MEDICAL CONDITIONS THAT WOULD LIMIT OR PROHIBIT ANY CHILD FROM PARTICIPATION
CHILD 1
CHILD 2
CHILD 3
SEE REVERSE SIDE

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Payment Policies

  • Payment is due at time of enrollment for the class and/or private lesson and on or before the 5thof each month thereafter.
  • A $15 late fee will be assessed to payments received after the 5th which must be paid before continuing with classes, private lessons, or any other services provided by Double Down Athletics.
  • An Annual Family Registration Fee is due everyJanuary for all participants joined on a team, class or private lesson. The fee is pro-rated throughout the year for those who begin team, classes or private lessons after June.
  • All classes, privates, and team athletes are required to be on automatic withdraw starting Jan 1, 2017. Double Down Athleticswill bill your credit card for monthly dues on the 5th of every month. In order to drop from classes and privates a 30 day notice is required. In order to drop classes and privates and discontinued your automatic payments you are required to come in and fill out a drop/stop payment form in person.
  • Credits will not be issued for any classes or privates lessons missed by the participant when no notification is given prior to absence to office staff. You may make prior arrangements to make up lessons before or after the absence.
  • Your monthly tuition will be invoiced to your Double Down Athleticsaccount on the 1st of every month. This invoice is for that current month of services.
  • Invoices are sent via email. If you do not receive an email, you are still held responsible to make your payment by the 5th of the month.
  • Double Down Athletics accepts cash, checks, Money Orders, Visa, MasterCard, and Debit. All cash payments are required to receive a receipt.
  • You may request a receipt, invoice or statement at the Double Down Athletics front office at any time.
  • Return Check Policy – All returned checks will be charged a $25 returned check fee. This fee and all previous fees must be paid before the participant receives any other services.
  • Credit Card Information on file will be charged by the 5thof the month, your credit card will be charged for the amount of payment due.
  • All prices charged by Double Down Athletics are derived from the “Double Down Athletics Price Listings” generated every quarter by Double Down Athletics management.
  • The Double Down Athletics “Medical Waiver and Release Form” binds individual(s) stated on attached form to the terms of this contract.

Injury or Illness Procedures

  • Injuries will be handled on an individual basis.
  • If classes need to be missed due to injury or illness, a signed doctor’s note must be provided to the Double Down Athletics front office staff to adjust any fees on your account.
  • If serious injury should occur, Double Down Athletics staff will do everything possible to contact a parent and any other stated emergency contact. If we are unsuccessful, we will contact emergency services and administer immediate medical treatment as deemed necessary.
  • If injuries occurs to the head, neck or back it is Double Down Athletics policy to call emergency services immediately to evaluate participant’s condition.
  • In the event of an injury, the coach, participant (if able), and participant’s guardian must fill out an injury report before leaving the facility.

Tumbling, Gymnastics and Cheerleading Classes Policies and Procedures

  • Class prices are based on one 55 minute session per week and four weeks per month. Due to observed holidays and months with a 5th week, it is possible you will receive 3 or 5 lessons. However, in either instance your monthly fee will not be adjusted.
  • Once you sign up for a class, you are committed to pay. If you decide to discontinue the class you must submit a written notice to a Double Down Athletics office staff member 2 weeks prior to ending the class.
  • Be aware if you choose to drop a class, you are responsible for payment until the written notice is turned in and the 2 weeks have passed.
  • You will not be refunded, credited, or offered make up classes for any classes missed by no show/no call. You may make prior arrangements to make up lessons before or after the absence but if a 5th week is offered during the months before, during or after your absence this extra class will be considered as the make up lesson.Private classes must be scheduled with the Double Down Athletics office staff. Private classes will follow the same procedure as “Private Lessons” (see “Private Lessons” below)
  • All classes on our Double Down Athletics schedule are open until the maximum capacity has been reached. In addition, classes are open to any participant who meets the qualifications as outlined by Double Down Athletics instructional staff. Instructors may use their discretion to admit and transfer a student from their class.
  • If class size falls below 3 students, Double Down Athletics may close or combine the class with another.
  • Pictures are often taken to use for Double Down Athletics advertisement on flyers, website, brochures etc. By signing below you give Double Down Athletics permission to use your child’s photograph for the specified purposes stated above.

Private Lessons/Private Classes

  • Private lessons are contingent upon instructor’s availability.
  • Instructors may not schedule private lessons. Private lessons are only scheduled with our Double Down Athletics office staff in accordance with instructor availability.
  • Private Lessons can not be scheduled between the hours of 5:00-7:00, Monday - Friday.
  • 30 minute Private lessons are limited to two people. The price listings are available at the Double Down Athletics front office.
  • 55 minute Private lessons are for up to four students. The price listings are available at the Double Down Athletics front office.
  • Private lesson pricing is based on four 30 minute or 55 minute sessions per month.In the event where a month may have five weeks, an additional payment for the fifth lesson would be required. Private lessons may be purchased in blocks of four and scheduled according to coach’s availability.
  • Once your private lesson is scheduled, the participant(s) are financially responsible for all payments, for lessons attended or missed.
  • You will not be refunded, credited, or offered make up lessons for any private lessons missed by no show/no call. You may make prior arrangements to make up lessons before or after the absence.
  • To discontinue private lessons a written notice must be turned into the Double Down Athletics office no less than 2 weeks prior to ending the lesson. If the written notice is not submitted, the participant will be responsible for payment until the form is filled out, received, and the 2 weeks have passed.
  • If any participant(s) withdraw, (participant must turn in a written notice) from a two or three person private lesson the remaining participant(s) will be responsible for payment of the one or two person lesson rate.
  • Private classes are classes of 5 or more students who have organized with Double Down Athletics a class that is open only to the participants who organized the class. Payment policies follow the same guidelines set forth in this section and in the “Payments and Procedures”. If attendance drops below 5 students, the fee may be adjusted, open to public or class may be cancelled.
  • Please see “Payment Policies and Procedures” for more payment information.
  • To switch times or instructors of private lessons, you must visit the front office.
  • Double Down Athletics will not match up partners for private lessons.
  • If the amount of private lesson members changes, it will be the remaining participant(s) responsibility to replace their partners in order to continue at the current rate. If new members are not added to the lesson, the monthly fee will be adjusted according to the remaining number of participants.

Open Gym & Pay as You Come Classes

  • Double Down Athletics classes listed as “pay as you come” and open gyms are to be paid on the day of class. Payment responsibility will not be deferred to your Double Down Athletics account. Credit issued by Double Down Athletics is eligible for payment.
  • Open gym participants and their guests do not have to be registered Double Down Athletics members but they must have a medical release waiver signed by a guardian on file in the Double Down Athletics office or submitted through our online registration.

Behavior and Conduct at Double Down Athletics Training Facility Including Affiliated Events

  • All members of Double Down Athletics are required to conduct themselves in a respectful, professional manner and exhibit good sportsmanship while in or representing the Double Down Athletics training facility.
  • No illegal substances, alcohol, tobacco, or weapons allowed in Double Down Athletics training facility or during affiliated events.
  • No foul or inappropriate language or behavior is permitted.Horseplay or any behavior deemed dangerous to Double Down Athletics staff is prohibited.
  • Participants training at Double DownAthletics are to participate in classes, private lessons or team practices with appropriate practice attire. Hair must be tied back and no jewelry may be worn during any class, private lesson, team practice or performance. If you are wearing attire inappropriate for practice or performance, you will be asked to change into appropriate attire before you may continue.
  • Participants will only enter training area when their team practice, class or lesson begins and a coach has called them out to the floor.
  • No food or drink is permitted in any training area in the gym. Food and drink must stay within the designated viewing area. Exception of water.
  • Only registered participants of Double DownAthletics are permitted in training areas. All spectators must stay within the designated viewing area only. Non registered spectators are strictly prohibited from all training areas.
  • Consequences for violating these rules may result in a warning, suspension, or dismissal from the facility by Double DownAthletics staff.

PARENT/GUARDIANS SIGNATURE / DATE / PARTICIPANT’S SIGNATURE (18 AND OVER) / DATE

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