REG8TRATON FORM

Please check one: .1he lllp lacLory

. 1lLans CymnasLlcs and Cheer

(|ease r|nt)
Ak1ICIAN1 INICkMA1ICN
-lckname __________________ Pome # ( ) _________________uaLe of 8lrLh _____/_____/_______
SLudenL's llrsL -ame _____________________ Mlddle _______________ LasL __________________________
SLreeL Address _________________________ AparLmenL # ______ 3r|rl 3|ze: .&% X3 (2-1) 3 (-8) V (10-12) L (11-1)
|ly: ________________3lale: ______ Z|p 4/e: ________________ 3r|rl 3|ze: .&L% 3 V L XL XXL XXXL
MoLher's -ame __________________________________ Work # ( ) __________________ # _________
Cell # ( ) __________________ Lmall ______________________________________________
laLher's -ame ___________________________________ Work # ( ) __________________ # _________
Cell # ( ) __________________ Lmall ______________________________________________
***1he l/ip loctory/1iton 6ymnostics ond cheer uses your emoi/ oddress for communicotion purposes on/y

CkLDI1 CAkD nCLDLk'S INICkMA1ICN
-ame on Card _____________________________________ Lxp uaLe _______________ Sec Code __________
lease clrcle Card 1ype MC vlSA Card -umber ________________________________________
l auLhorlze monLhly deblL Lo Lhls credlL card Lo 1he lllp lacLory /or 1lLans CymnasLlcs and Cheer
Cardholder's SlgnaLure _________________________________________1oday's uaLe _____/______/______

NC1L
PereafLer any menLlon of 1he laclllLy" shall refer Lo 1he lllp lacLory 1lLans CymnasLlcs and Cheer pald sLaff and/ or lLs volunLeer
represenLaLlves LhaL may be appolnLed by 1he lllp lacLory or 1lLans CymnasLlcs and Cheer

kLGIS1kA1ICN ILL kICLS
1here ls a 8eglsLraLlon lee per famlly due along wlLh Lhe 1sL monLhs paymenL 1here ls a $300 dlscounL on reglsLraLlon lf you slgn
up for AuLoay 8eglsLraLlon fees are Lransferrable beLween 1he lllp lacLory and 1lLans CymnasLlcs and Cheer
lease see your lnformaLlon ackeL for 8eglsLraLlon and Class prlclng

MCN1nL AMLN1S
aymenLs are due on Lhe ll8S1 of each monLh and a 52000 lote fee wlll be added Lo any paymenL recelved afLer Lhe 10
Lh
(LenLh) of
Lhe monLh lf paymenL ls noL recelved by Lhe 13
Lh
(flfLeenLh) of Lhe monLh Lhe chlld wlll be dropped from Lhe class and noL allowed
Lo reLurn unLll paymenL ls recelved 1here ls a $2000 reLurned check fee lf you are dropplng a class for any reason lL musL be puL
ln wrlLlng and glven Lo Lhe gym before Lhe flrsL of Lhe monLh LhaL you wlsh Lo drop CLherwlse you wlll be responslble for LhaL
monLh's full paymenL

CkLDI1 CAkD kCCLSSING
CredlL card wlll be processed on Lhe 1
sL
of each monLh unless Lhe flrsL falls on Lhe weekend lf Lhe daLe falls on Lhe weekend Lhe card
may be processed on Lhe lrlday prlor Lo Lhe 1
sL
of Lhe monLh or Lhe proceedlng Monday

LkMISSICN kLLLASL
l glve my permlsslon for 1he laclllLy" Lo phoLograph and vldeoLape my chlld for llLeraLure/adverLlslng purposes lurLhermore l
undersLand LhaL by parLlclpaLlng ln Lhls program LhaL my chlld and hls/her Leam may appear ln phoLos/vldeos/lmages for ouLleLs
such as buL noL llmlLed Lo @e loce 1wlLLer lllckr lcasa newspapers Lelevlslon appearances commerclals eLc 1hls
may lnclude any member of our famlly who ls a specLaLor aL 1he laclllLy" an ouLlng or evenL held ouLslde 1he laclllLy"

l reallze LhaL classes depend on Lhe amounL of parLlclpanLs Should Lhere be a decllne or lncrease ln parLlclpanLs my chlld's class
may be changed Lo a dlfferenL Llme or day Should my chlld aLLaln or lose skllls he/she may be placed ln a dlfferenL class dependlng
on hls/her sklll level

arenL/Cuardlan SlgnaLure (or Self lf over 18)____________________________________________ uaLe _____/_____/______
MEDCAL
RELEA8E FORM






PereafLer any menLlon of 1he laclllLy" shall refer Lo 1he lllp lacLory 1lLans CymnasLlcs and Cheer pald sLaff and/ or volunLeer
represenLaLlves LhaL may be appolnLed by 1he lllp lacLory or 1lLans CymnasLlcs and Cheer

l _______________________________ glve my .chlld .self _________________________________ permlsslon Lo
parLlclpaLe ln classes and programs LhaL are offered by 1he lllp lacLory and 1lLans CymnasLlcs and Cheer whlch lnclude buL are noL
llmlLed Lo cheerleadlng gymnasLlcs and Lumbllng l undersLand LhaL Lhere ls a posslblllLy for ln[ury some caLasLrophlc and LhaL
safeLy precauLlons wlll be Laken l do noL hold #@e loclllty or my chlld's daycare preschool or school (lncludlng Lhelr
sLaff/volunLeers) responslble for any ln[ury resulLlng ln my chlld's parLlclpaLlon of programs offered by #@e loclllty

l fully undersLand LhaL Lhe sLudenLs are noL lnsured agalnsL ln[urles and l agree Lo Lake full responslblllLy ln paylng for any medlcal
care LhaL Lhe sLudenL may have Lo recelve lf hurL whlle parLlclpaLlng wlLh 1he laclllLy" l undersLand LhaL 1he laclllLy" and Lhelr
represenLaLlves are noL medlcal professlonals however Lhey wlll admlnlsLer llrsL Ald Lo my chlld/chlldren ln Lhe evenL of lllness or
ln[ury l glve permlsslon for a physlclan hosplLal or ambulance Lo be conLacLed Lo ensure prompL care durlng Lhe evenL of a serlous
ln[ury

l reallze lL ls my responslblllLy Lo ensure LhaL my chlld and l are fully aware of Lhese dangers 8y auLhorlzlng my chlld Lo parLlclpaLe ln
classes programs or evenLs LhaL are offered by #@e loclllty l acknowledge Lhe rlsks assoclaLed wlLh Lhese sporLs programs evenLs
and classes

l walve and release 1he lllp lacLory 1lLans CymnasLlcs and Cheer and Lhelr sLaff/volunLeers/represenLaLlves from any and all
damages clalms LhaL may be assoclaLed wlLh Lhe fore menLloned acLlvlLles/sporLs l reallze LhaL Lhls walver also applles Lo anyone
who mlghL represenL me such as buL noL llmlLed Lo currenL or fuLure helrs and execuLors

l also undersLand LhaL lf my chlld cannoL behave whlle parLlclpaLlng ln any program or class LhaL ls offered by #@e loclllty he/she
wlll be senL ouL of class 1hls ls for Lhe safeLy of my chlld and Lhe oLhers parLlclpaLlng ln our programs

l cerLlfy LhaL l wlll provlde ample lnsurance Lo cover my chlld and myself from ln[urles/accldenLs LhaL may occur durlng classes
evenLs or programs offered by 1he lllp lacLory and 1lLans CymnasLlcs and Cheer

A81lClA-1'S -AML ____________________________________ uA1L Cl 8l81P _______/________/________
S18LL1 Auu8LSS _____________________________________________________ AA81ML-1 # _________________
Cl1? ______________________________ S1A1L _______________ ZlCCuL ________________________
PCML PC-L ( )_________________________ A81lClA-1'S CLLL ( ) _______________________________
A8L-1/ CuA8ulA-'S -AML________________________________ LMAlL Auu8LSS _____________________________
A8L-1/ CuA8ulA- PCML # ( )___________________ A8L-1/ CuA8ulA- CLLL # ( ) ___________________

#1) LML8CL-C? CC-1AC1 (-ame) _____________________________________ 8LLA1lC- ______________________
PCML # ( )_____________________ CLLL # ( )____________________________

#2) LML8CL-C? CC-1AC1 (-ame) ____________________________________ 8LLA1lC- ____________________
PCML # ( )___________________ CLLL # ( )________________________________

MLulCAL l-Su8A-CL 8CvluL8 _______________________________________ PC-L # ( )_______________
CLlC? -uM8L8 _________________________________________ C8Cu -uM8L8 _________________________
arenL/ Cuardlan's SlgnaLure_______________________________________ uaLe___/___/_____
ulrecLor's SlgnaLure__________________________ __________ _______ uaLe___/___/_____