Ingrid’s Gymnastics and Cheer, LLC
Name: ______________________________Age ____ Date of Birth: __________ Gender _______
Address: __________________________________City ____________________ Zip ___________
Email address: ________________________________ Home phone: _______________________
Mother’s name: ____________________________Cell #: _____________ Work #: ____________
Father’s name: _____________________________Cell #: _____________Work #_____________
Emergency contact (other than parents)______________________________ Phone #:__________
Persons to whom child may be released _____________________________Phone #:__________
_____________________________ Phone #: __________
Health Insurance Company ________________________contract# _________________________
Group # _________________Effective Date ___________Policy Holder_ ____________________
Allergies / health problems: ________________________ Medications: _____________________
Being the parent and/or legal guardian of _____________________________, I fully understand that the nature of gymnastics involves jumping, twisting, flipping, landing, etc. Precautions are in place at the gymnasium to protect my child from injury but accidents, however rare, are possible. I am wiling to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in gymnastics and that my child is healthy with no physical or mental disabilities that would restrict full participation in the activities of the gymnastics and cheer programs. In addition to giving my full consent for my child’s participation, I do hereby waive, release, and hold absolutely harmless Ingird’s Gymnastics and Cheer, LLC and its coaches for any injury that may be suffered by my child, whether the result of negligence or any other cause. I understand that Ingrid’s Gymnastics and Cheer,LLC will not be liable in any way for medical, doctor, hospital, or dental expenses. It is my specific understanding by signing this document that all parents and guardians of my child will be giving up the right to all claims, suits, causes of actions, demands, monies, attorneys fees and judgments.
I, ________________________________ give my permission to Mrs. Ingrid Pfau to authorize any emergency medical treatment that my child/ward may require during the 2012-2013 gymnastics session.
Ingrid’s Gymnastics and Cheer, LLC
Tuition and Payment Policies
*Students may sign up any time during the month, and tuition will be pro-rated.
*Monthly tuition is due on the first week of each month. A $10 late fee will be added to all overdue accounts on the 10th of the month.
Methods of payment:
Cash. A written receipt will be provided for cash payment. Place the payment in an envelope with your child’s name and the month.
Check. There will be a $30 charge for returned checks. Your child’s name and month of payment must be written on the check.
Debit or Credit. Your child’s name and month of payment must be written on the receipt.
All outstanding balances are due before starting each school year, and all accounts overdue 90 days will be sent to ACES Collection Agency.
*Student cannot attend classes if accounts are delinquent for over 30 days.
*Unused tuition payments due to injury or illness will be credited to your account for future use but will not be refunded.
* Full tuition is due for each month including, December and March. Classes not held for holidays are made up in months that have extra weeks.
$35.00 annual fee per child
*Fee per month:
Beginners, intermediate & advanced $50.00
Pre team $90.00
Team – 2 times per week $100.00
3 times per week $135.00
*Second child discount $5.00 off per month
*Discount rate: For any additional class your child takes or for any additional enrollment in the program, you will receive a $5.00 discount per month on your tuition.
Parent/Guardian Signature Date
Student Signature Date