Sky Valley Academy Summer Camp Registration Form  ___#1______#2______#3______#4______#5______#6______#7______#8______#9______#10______#11 _____Mon  _____Tue  _____Wed  _____Thur  _____Fri CHILDS NAME:_____________________________________________________________________________D.O.B____________________ CHILDS NAME:_____________________________________________________________________________D.O.B____________________ CHILDNAME:_______________________________________________________________________________D.O.B____________________ ADDRESS:__________________________________________________________________________________________________________ CITY:______________________________________________________________STATE:____________________ZIP:___________________ PARENTS NAMES:____________________________________________/_____________________________________________________ CELL:___________________________________________________/__________________________________________________________ E-MAIL:_____________________________________________________/_______________________________________________________ EMERGENCY CONTACT:___________________________________________________________________________________________ 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, 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. 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 of any and all responsibility due to injury. PRINTED NAME OF PARENT OR GUARDIAN:__________________________________________________________________________ Signature of Parent/Guardian:__________________________________________________________________________________________