FALL S1 □
TUMBLING TITANS REGISTRATION FORM SPRING S2 □
SUMMER □
Child’s Last Name ______Child’s First Name ______
DOB ___/____/____ M / F Home Phone #______Health Insur. Carrier______
E-mail ___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Home Address ______
Street City State Zip
Mother’s Name______Mother’s Cell #______Mother’s Work #______
Father’s Name______Father’s Cell #______Father’s Work #______
Emergency Phone #______Name ______Relationship ______
CLUB WAIVER AND RELEASE FORM
World Cup Gymnastics and its staff recognize our obligation to make our clients aware of the risks and hazards associated with the sport of gymnastics, tumbling, cheerleading, Romperee, trampoline, etc. World Cup Gymnastics and its staff will not accept responsibility for injuries sustained by any child, parent and/or caregiver during the course of any gymnastics activities and/or while arriving or departing or waiting anywhere on World Cup Gymnastics premises. Parents and/or caregivers should be aware of, and educate their children about the possibility of injury. Parents and/or caregivers should also encourage their children to follow all safety guidelines and World Cup staff instructions. Gymnastics can be dangerous and lead to injury. Students, parents and/or caregivers may suffer injuries, possibly minor, serious or catastrophic in nature.
Therefore, being fully aware of the risks and possibility of injury involved, I consent to have my child and/or myself participate in the programs offered by World Cup Gymnastics. I waive and release all rights and claims for damages that I or my child may have against World Cup Gymnastics and/or its representatives and staff, whether paid or volunteer. With this in mind, in the event of an injury or illness to my child or myself, and with the knowledge that World Cup staff members are not physicians or medical practitioners of any kind, I consent to the administration of temporary first aid to me and/or my child by World Cup staff if they deem it necessary, contacting a doctor and/or seeking medical help, transportation by a World Cup staff member and/or its representatives, whether paid or volunteer, to any health care facility or hospital, calling 911 and/or an ambulance, etc. I also affirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage which I consider adequate for both my child’s and/or my own protection. I also understand that it is my responsibility to continually remind my child about the dangers of gymnastics, tumbling, cheerleading, Romperee, trampoline, etc. injury. World Cup Gymnastics staff members will continually remind the children, parents and/or guardians of safety guidelines during our programs, as well as post signs throughout the premises.
PHOTO RELEASE: I authorize that World Cup Enterprises LLC has the right to use all photographs or videos taken of my child or children during camp/classes/practices/field trips, etc. for advertising or promotional material, or on its website.
REGISTRATION INFORMATION AND POLICIES
Waivers: A waiver MUST be filled out and signed before any child may participate in any class. Waivers are available at the front desk.
Annual Registration Fee: Our registration fee is $50.00 per child when paid with Session 1 ($40 with Session 2; $30 for Summer). It is valid through August, 2017. Annual registration fees are non-refundable and non-transferable. Sibling discounts do not apply to registration fees.
Sibling Discounts: If your child’s sibling is enrolled in any programs at World Cup Gymnastics, we will deduct 10% from the lesser of the tuition(s).
Multiple Class Discounts: When a child takes more than one class during the session, we will deduct 10% from the lesser of the tuition(s).
Closures: In the event of inclement weather or to check on holiday closures, please call our Front Desk at ext. 10 BEFORE COMING TO THE GYM. If we are not available, our outgoing message, website and Facebook page will have all relevant information regarding closures or delayed openings.
Make-ups: If your child cannot make his/her scheduled class, please call the Front Desk ahead of time and notify us of the absence. This will allow another child to occupy that spot, and you can schedule your own make-up class at the same time. A maximum of 3 make-up classes will be allowed in Sessions 1 and 2, and 2 make-up classes in the Summer. Make-ups cannot be carried over into the next session or transferred to a sibling or friend. No make-up classes are permitted in the first week of a session. You may schedule make-up classes by phoning the Front Desk at (914)
238-4967, ext. 10. If you schedule a make-up class but find you cannot make it, you must call the Front Desk to cancel the make-up or you forfeit that make-up class (your space was held). Please schedule your make-ups as soon as possible. Make-up classes are non-transferable.
Class transfers: An administration fee of $10.00 will be charged for any class transfer initiated by a parent or guardian at any time during the session. This fee is due before the transfer can take place. Classes are NOT transferable within a family.
Refunds/Credits: No refunds will be given for missed classes. If a student withdraws after the first class, a full refund will be given for the remaining classes. However, after the second class, the refund will be 80% of the remaining classes. The registration fee is NOT refundable under any circumstances. If you decide to cancel your class for any reason, you must notify World Cup Gymnastics as soon as possible. Your refund will be calculated from the date of notification.
While at World Cup Gymnastics: Siblings are not allowed to participate in the gym class and must remain behind the half-wall during the class. Parents are not allowed on the gym floor at any time, except where REQUIRED by the class description. Spectators may observe classes from the balcony or hallways. World Cup Gymnastics is not responsible for any lost or stolen items. No child under the age of 12 may be left unattended on the premises, and must be supervised at all times. Please have your children obey the posted Gym Rules and Policies at all times.
______
Print Parent’s/Caregiver’s/Participant’s Name Parent’s/Caregiver’s/Participant’s Signature Date
Payment Information: NO REGISTRATION WILL BE ACCEPTED WITHOUT FULL PAYMENT
Credit Card No.:______Exp.:______Authorized Signature: ______
In order for our coaching staff to create the best environment that is most appropriate for your child, please fill out this questionnaire to the best of your ability.
Special Needs Classification (Autism, Intellectual Disability, etc.): ______
Verbal or Nonverbal (circle selection)
Physical Tendencies: ______
______
Potential Triggers/Fears: ______
Effective Calming Techniques: ______
______
Any Physical Injuries/Ailments: ______
Is your child physically independent? Yes or No (circle selection)
Anything else we should know about your child?______
______
FOR OFFICE USE ONLY:
Session / Day / Class / Time / Sibl. Disc. / Tuition / Wks / Reg.fee / Pymt
Date / Pymt
Type / Ref. # / Pymt
Amt. / (√) EZ
Care / Notes
1
2
Summer