registration paperwork - Green Mountain Gymnastics

Green Mountain Training Center
2015 Gymnastics Summer Camp Registration
Child Name:
DOB:
Age:
o Male
o Female
Street:
City:
Zip
Parents/Custodial parent or legal guardian:
Phone Numbers
Parent:
Home
Work
Cell
Spouse/Partner:
Email Address:
(GMG may use this for informing parents of class changes or any upcoming events)
Person responsible for payment on this account:
Street:
Home Phone:
City:
Work Phone:
Doctor’s Name:
Cell Phone:
Zip:
Email:
Doctor’s #:
In case of emergency, please call:
Name:
Phone:
Relationship:
Name:
PLEASE INFORM US OF ANY MEDICAL CONDITIONS OR ALLERGIES
OFFICE USE ONLY:
R:
W:
D:
PIF:
CL:
OP:
Summer Camp 2015 Schedule
Please circle all of the sessions your child will be attending
Session
Dates
Times
Check
Rate
Tiny Flips (Ages 4-6)
Tiny Flips 1
June 22 – June 26
8:00 – 12:00
$150
Tiny Flips 2
July 20 – July 24
8:00 – 12:00
$150
8:00 – 12:00*
$150
8:00 – 4:00*
$270
8:00 – 12:00*
$125
8:00 – 4:00*
$220
8:00 – 12:00*
$150
8:00 – 4:00*
$270
8:00 – 12:00*
$150
8:00 – 4:00*
$270
8:00 – 12:00*
$150
8:00 – 4:00*
$270
8:00 – 12:00*
$150
8:00 – 4:00*
$270
8:00 – 12:00*
$150
8:00 – 4:00*
$270
Summer Flips (Ages 6-12)
Summer Flips 1
June 22 – June 26
Summer Flips 2 (4 Day Camp)
June 29 – July 2 (4 Days)
Summer Flips 3
July 6 – July 10
Summer Flips 4
July 13 – July 17
Summer Flips 5
July 20 – July 24
Summer Flips 6
August 3 – August 7
Summer Flips 7
August 10 – August 14
Total Due
*Please note that ALL camps end at 12:00 on Friday after the end of the week performance, which will be
held at 11:30.
OFFICE USE ONLY:
Deposit Paid
A non‐refundable deposit of $75 is
required for each session attending &
must be paid with registration
Balance Due:
th
th
June 15 for all June sessions, June 29 for all July
sessions and July 27th for all August sessions.
Date:
Amount:
Date:
Amount
RELEASE OF LIABILITY, WAIVER OF CLAIMS
ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
By signing this document you will waive certain legal rights, including the right to sue.
PLEASE READ CAREFULLY
AWARENESS AND ASSUMPTION OF RISK
I am aware that trampoline and gymnastics involves risk including risk of personal injury, death, property
damage, expense and related loss, including loss of income. Included in these risks are negligence on the part
of Green Mountain Gymnastics/ Green Mountain Freestyle, its directors, officers, officials and volunteers, other
participants and owners of the facilities where the activities occur (referred to in the rest of this agreement as
“GREEN MOUNTAIN GYMNASTICS AND OTHERS”). I freely accept and fully assume all such risks and the
possibility of personal injury, death, property damage, expense and related loss, including loss of income.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of Green Mountain Gymnastics accepting my application to participate in this activity, I agree:
1.
2.
3.
4.
To waive any and all claims that I may have in the future against GREEN MOUNTAIN GYMNASTICS AND
OTHERS.
To release GREEN MOUNTAIN GYMNASTICS AND OTHERS from any and all liability for any personal injury,
death, property damage, expense and related loss, including loss of income that I or my next of kin may suffer
as a result of statutory duty of care.
To hold harmless and indemnify GREEN MOUNTAIN GYMNASTICS AND OTHERS from any and all liability for
any damage to property of, or person injury to, any third party, resulting from participation in this activity.
That this agreement is binding on not only myself but my next of kin, heirs, executors, administration and
assigns.
PARTICIPANT CONSENT AGREEMENT
1.
2.
3.
4.
5.
6.
I warrant that the participant named on this form is physically fit to participate in trampoline and gymnastics
activities.
I declare that I have accurately disclosed all information regarding physical, emotional or mental conditions
affecting the named participant and acknowledge that this information may be used by GREEN MOUNTAIN
GYMNASTICS AND OTHERS to use in the delivery of a trampoline and gymnastics program.
I understand that GREEN MOUNTAIN GYMNASTICS AND OTHERS has tried to create a safe and controlled
environment for participation and that the club has established rules for participation on and about the
trampoline and gymnastics areas that must be followed by the participant. I understand that failure to comply
with any of the policies and rules of GREEN MOUNTAIN GYMNASTICS AND OTHERS may result in the
suspension or termination of membership.
I hereby give permission for emergency medical treatment to be administered to the names participant.
It is understood that whenever reasonably possible, relatives will be contacted and informed of the problem,
diagnosis, treatment required and anticipated medical results.
I hereby, where applicable, give permission for my son or daughter (or person to whom I am the legal guardian)
to participate in Green Mountain Gymnastics programs.
I HAVE READ THIS AGREEMENT AND UNDERSTAND IT. I AM AWARE THAT BY SIGNING THIS
DOCUMENT I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE, WHICH I OR
MY NEXT OF KIN, HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST
GREEN MOUNTAIN GYMNASTICS AND OTHERS.
Date signed:________/_________/________
Date signed:________/_________/________
____________________________________
Signature of Parent of Guardian (if under 18)
____________________________________
Signature of Applicant (if over 18)
____________________________________
Please print name clearly
____________________________________
Please print name clearly
IMPORTANT INFORMATION
For Green Mountain Gymnastics Summer Camps
Deposits and Payments
 A $75.00 non-refundable deposit is required for each session attending and
must be paid with registration.
 Balance for camps are due by 6/15 for all June camps, 6/29 for all July
camps and by 7/27 for all August camps.
What to wear:
 Girls will be more comfortable if they wear a leotard. If they choose not to,
then we ask that no baggy clothes are worn and nothing with buckles
zippers snaps or belts.
 Boys should wear and elastic waist shorts and a t-shirt tucked in.
What to bring:
 ½ day campers should bring a morning snack and at least water bottle. We
do have a Healthy Snack vending machine here on premises offers snacks,
juices and water bottles. We do not have a water fountain so please make
sure that kids are bringing in a refillable water bottle or have money to buy
one out of the machine.
 Full day campers need to bring 2 snacks, and a bag lunch and plenty of
water.
 Sneakers for outdoor playing
Drop off and pick up information
 Drop off starts at 8:00 with gymnastics starting at 8:30 sharp.
 ½ day campers should be picked up each day by 12:00, and will participate
in the end of week show which starts at 11:30 on Friday.
 Full day campers should be picked up Monday-Thursday by 4:00. Friday pick
up is at 12:00 after our end of week show which is at 11:30.
Other Notes
 There are no refunds or make up classes for missed days.
 No one is allowed on any equipment unless with a coach.
 We always wait to go onto the gymnastics area until we are called out by
one of our coaches.
 If less than 5 students are enrolled, GMG reserves the right to cancel camp
for that week. We will do our best to give as much notice as possible and full
refunds will be given in this situation
Cancellation policy
 The $75.00 deposit per student per week is NON REFUNDABLE
If payments are made in full and a cancellation is made with a 30-day notice,
the tuition minus the deposit will be refunded. If a cancellation is made with
less than a 30-day notice, then no refund will be given at all.
`