Sky Valley Academy Registration Form 2009 -2010
Class Day________Time_______Reg Paid________1st Mo. ________Last Mo.________Date Received
_______
___Parent Toddler ____3 year olds ____4 & 5 year
olds ____Boys Bombers____Girls Blue Angles____Cheer
___Boys
Pilot Team ___Girls Pilot Team____JO Team ____Tae Kwon Do ____Tumbling____Hip Hop____Ballet
CHILDS NAME:_____________________________________________________________________________D.O.B____________________
CHILDS NAME:_____________________________________________________________________________D.O.B____________________
PARENTS NAMES:____________________________________________/_______________________________________________________
HOME:____________________________________________________CELL:____________________________________________________
E-MAIL:_____________________________________________________/_______________________________________________________
ADDRESS:__________________________________________________________________________________________________________
CITY:______________________________________________________________STATE:____________________ZIP:___________________
EMERGENCY
CONTACT NAME:___________________________________________________________________________________________
CONTACT PHONE:____________________________________________________________________________________________________
ALLERGIES:________________________________________________________________________________________________________
PARENT SIGNATURE:______________________________________________________Todays Date:_________________________
Funds are non-refundable: You may transfer monies to another class, open gym or birthday party within
the same family. Make up classes are available in a 5 week month, pick up a make up coupon at the front counter. Coupons
may not be applied towards tuition. Make up classes are limited to days, times and classes available. You must give a 30 day
notice prior to discontinuing class. If notice is not given your last month will be applied to the month notice was not received.
How did you hear about us:__________________________________________________________________________________________
In consideration of my membership in Sky Valley Gymnastics Academy, and my participation in Sky Valley Gymnastics
classes, events, and activities, I agree to be bound by each of the following:
1.
Eligibility: I agree to comply with the rules of Sky Valley Gymnastics Academy
2.
Readiness to participate: I will only participate in those activities, classes, events, competitions and parties for
which I believe I am physically and physiologically prepared. Prior to participation, I will have practiced my exercise 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 Sky Valley Gymnastics Academy and or the Host Organization to provide, through a medical staff of its choice,
customary medical/athletic training 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 risk, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated
with participation in gymnastics classes and all other classes offered at Sky Valley Gymnastics Academy.
Insurance Information:
Primary Medical Insurance: I am covered by a primary health /medical / accident
insurance through, _______________________________________________________________#___________________________________________________
I hereby release Sky Valley Gymnastics Academy, Staff, Coaches & Volenteers of any and all responsibility
due to injury during activities, camps, clinics, field trips, birthday parties, preschool, parents night out and any other
event while attending Sky Valley Academy.
PRINTED NAME OF PARENT OR GUARDIAN:__________________________________________________________________________
Signature of Parent/Guardian:_____________________________________________________________________________________
