2008 Registration /Release Form (Winter/Spring/Summer Sessions)
Please print,
complete, and include a $10.00 Registration fee then mail it to:
STUDENT INFORMATION
Child’s Name:________________________________________Sex:__________Birthdate:________________
School:______________________________________________Grade:_______________Age:_____________
Address:____________________________________________City:_________________Zip:______________
Email address:______________________________________________________________________________
Home Phone:_______________________Emergency Contact
Person:_________________________________ Health Concerns of
Student___________________________________________________________________
PARENT INFORMATION
Father:_________________________Employer:_____________________________Phone:________________
Mother:________________________Employer:_____________________________Phone:________________
Insurance Company:__________________________________________Policy
#________________________
How did you hear about
CLASS INFORMATION *Day and Time of Class(es)_________________________________________
___Mom/Dad
& Me (3 yrs. & under) ___Rec. Beginner I (61/2 - 9
yrs.)
___Pregym (2 ˝ - 3 ˝ yrs.) ___Rec.
Beginner II (10 – 13 yrs.)
___Pregym
(3 ˝ - 4 ˝ yrs.) ___Rec.
Intermediate I (6 – 9 yrs.)
___Pregym
(4 ˝ - 5 ˝ yrs.)
___Rec. Intermediate II (10 – 13 yrs.)
___Kinderkids (5 ˝ - 6 ˝ yrs.) ___Advanced
Tumbling.
___ Special
Needs Program
___ Cheerleading
___ Sword
Fencing ___ Boy's Recreation
___ Dance/Gymnastics Comb.
Class ___ Karate
COMPETITION LEVELS (by
invitation only)
___ Girls Preteam
(4 - 6
yrs.)
___ Level Five (7 - 16 yrs.)
___ Level Two (5 - 10 yrs.) ___ Level Six (7 - 18 yrs.)
___ Level Four (6 - 14 yrs.) ___
Optional Teams (Level 7 - 10)
___ Team Rec/Prep op. (6 - 16 yrs.)
(GIRLS) ___ Boy's Preteam (5 - 7yrs.)
___ Tumbling & Trampolining
(CO-ED) ___ Boy'sTeam
(6 - 18 yrs.)
Olympia School of Gymnastics provides a
Secondary Accident Insurance Policy. EACH STUDENT MUST HAVE THEIR
OWN PRIMARY INSURANCE. Students must at all times abide by the safety
standards of Olympia School of Gymnastics. Any abridgement of these standards
will be cause for dismissal. It is the policy of Olympia School of Gymnastics
not to refund tuition fees except in the case of relocation, class cancellation
or injury/illness with Doctor's notification. A registration fee of $25.00 is
due upon registration and is good until next fall. Registration fees are
NON-REFUNDABLE. STUDENTS MAY NOT ATTEND CLASS UNLESS ALL FEES ARE CURRENT.
There will be no provision for pro-rated tuition payments, with the exception
of a student's first month at Olympia School of Gymnastics when enrolling after
the fifteenth of the month. A $15 late fee will be charged for tuition payments
made after the 5th of each month.
In consideration of my and/or my child(ren's)
participation in activities of Olympia School of Gymnastics, Inc., I the
undersigned (parent or guardian of minor) agree to be bound by each of the
following:
1. I do grant authority to the staff of Olympia School of Gymnastics to render
judgment concerning medical assistance in the event of accident or illness.
2. I am fully aware of and appreciate the risks, including the risk of
catastrophic injury, paralysis and even death associated with participation in
gymnastics activities. I have communicated these to my child(ren).
I further agree that Olympia School of Gymnastics, Inc., its officers, and
staff shall not be held liable for any losses or damages occurring as a result
of my child(ren's) participation.
Signature of:_____________________Parent/Guardian__________________________Printed
Name__________Date
TUITION IS DUE BY THE FIFTH, (5th) DAY
OF EACH MONTH!