CLEMMONS GYMNASTICS CENTER
REGISTRATION FORM
*Please see brochure Class Choice: Level ________
for registration details Day ________ Time _______
Student’s Name _________________________________________________ Birthday ___________________________
Address ____________________________________________ City, State, Zip_________________________________
Parents’ Name: Mother ______________________________ Father__________________________________________
Phone #’s: Home _______________________________ Parent(s) Work_______________________________________
Email Address:__________________________________________Would you like to receive emails from us? _______
Special Physical or Medical Conditions ______________________________ Explain ___________________________
PARENT’S OR GUARDIAN’S ADDITIONAL INDEMNIFICATION
(Must be completed for participants under the age of 18)
In consideration of ____________________________ (print minor’s name) (“minor”) being permitted by CGC to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless CGC from any and all Claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
Parent or Guardian: ___________________________ Print Name: _____________________________ Date:_________
__________________________________________________________________________________________________
PARTICIPANT AGREEMENT RELEASE FORM AND ASSUMPTION OF RISK
In consideration of the services of Clemmons Gymnastics Center, Inc., hereinafter collectively referred to as “CGC”, their agents, owners, officers, employees, and all other persons or entities acting in any capacity on their behalf, I hereby agree to release and discharge CGC, on behalf of myself, my children, my parents, my heirs, assigns, personal representatives and estate as follows:
1. I understand and acknowledge that the activity my child is about to engage in poses known risks and unanticipated risks which could result in injury, paralysis, death, emotional distress, or damage to my child, to property, or to third parties.
The following describes some, but not all, of those risks: Gymnastics entails certain risks that simply cannot be eliminated without jeopardizing the essential qualities of the activity. Without a certain degree of risk, gymnastics students would not improve their skills, and the enjoyment of the sport would be diminished. Gymnastics exposes its participants to the usual risk of cuts and bruises. Other more serious risks exist as well. Participants often fall off equipment, sprain or break wrists and ankles, and can suffer more serious injuries as well. Traveling to and from shows, meets and exhibitions raises the possibility of any manner of transportation accidents. In any event, if your child is injured, your child may require medical assistance at your expense.
1. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, no one is forcing me or my child to participate, and we elect to participate in spite of the risks,
2. I hereby voluntarily release, forever discharge and agree to hold harmless and indemnify CGC from any and all liability, claims, demands, actions or rights of action, which are related to arise out of, or are in any way connect
with my child’s participation in this activity.
3. Should CGC, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnity and reimburse them for such fees and costs.
4. I certify that my child has health accident and liability insurance to cover any bodily injury or property damage that may be caused or suffered while participation in this event or activity, or else I agree to bear the costs of such injury or damage to my child. I further certify that I am willing to assume the risk of any medical or physical condition my child may have or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition.
5. In the event that I file a lawsuit against CGC, I agree to do so solely in the state of North Carolina, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portion shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against CGC on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Signature of Participant or parent___________________________________ PrintName__________________________
Address___________________________________________________________________________________________
Phone ____________________________________________________________ Date ___________________________
SAFETY RULES
We at the Clemmons Gymnastics Center feel there are certain qualifications and standards that are necessary to ensure a safe, secure and satisfying gymnastics environment in our facility.
- No one may go on the floor or any equipment at any time without an instructor present.
No jewelry may be worn.
- No food, gum, candy, or drinks are permitted on the floor.
- If you have other children in the lobby, CLEAN UP AFTER THEM.
- Horseplay will not be allowed.
- No new skills may be attempted without an instructor's permission.
- A positive attitude is required at all times.
If you ever have any questions, concerns, comments, criticisms or compliments about our program, please call
Pam Lowder at the gym.
REGISTRATION RULES AND POLICIES · Registration: $25 is due before you start your class. This is required to reserve a space in a desired class. - No reservations will be made without payment or a completed registration form.
- We reserve the right to cancel or combine classes if a minimum enrollment is not met.
- We do not require you to sign a contract. However, we assume all our students will continue throughout the session unless we receive a 30 day written notice prior to leaving the program. Failure to do so will result in a charge for the month.
Our Discount Policy: Families registering more than one child, or for more than one class will receive a discount. Make-up Policy: One make-up class per month is permitted and must be made up within one month of missed class. Please call the gym to schedule a make-up. Fees: Tuition is due on the 1st of each month. If tuition is received after the 10th a $10 late fee will apply. You may mail your tuition check or drop it in our tuition box at the lobby. Please put your child’s first & last name in memo. Check or cash ONLY. Returned Check Fees: There is a $25 charge for returned checks and a $10 late fee charge. Assumption of Risk Policy: I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Clemmons Gymnastics Center on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. No Refund Policy: WITHOUT ANY EXCEPTION there are NO REFUNDS for any paid program here at Clemmons Gymnastics. WRITTEN NOTICATION OF WITHDRAWAL TO THE OFFICE (NOT THE INSTUCTOR) IS REQUIRED 30 DAYS IN ADVANCE OF WITHDRAWING A STUDENT FROM THE PROGRAM. PAYMENT IS REQUIRED AT THAT TIME THROUGH FINAL DATE OF WITHDRAWAL Date: _______________
Print Child’s Name: _______________________ Signature of Participant or Parent: _________________________
By signing this form you have acknowledged our SAFTEY RULES, REGISTRISATION RULES, POLICIES, 30 DAYS WRITTEN NOTICE, ASSUMPTION OF RICK POLICY, and WITHOUT ANY EXCEPTION there are NO REFUNDS.
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Click here for a printable version of our registration form...Gym Registration.doc