2007 Registration /Release Form Please Print completed form and mail to:

Olympia School of Gymnastics159 PEM Drive Hendersonville, NC 28792

We will contact you by telephone or email to confirm registration and class placement for your child.                  

STUDENT INFORMATION

Child's Name:________________________________________ Sex:____ Birthdate:__________
School:_____________________________________ Grade:_________ Age:_______________
Address:___________________________________ City:_______________Zip:_____________
Home Phone:__________________ Emergency Contact Person & No:_____________________
Health Concerns of Student:_______________________________________________________
Email address:__________________________________________________________________
PARENT INFORMATION

Father:______________________ Employer: _______________________Phone:___________  Mother:______________________Employer:________________________Phone:___________
Insurance Company:______________________________________ Policy #________________
How did you hear about Olympia? Friend __Who?___________________ Other ____________

CAMP INFORMATION
Please check the Week(s) your child is attending camp, Full Day or Half Day, Three Days per week or Monday - Friday, and if AM or PM Extended Care is needed for your child.

Week(s)

Full Day / Half Day

3 Days or Full Week

AM / PM EXT. Care

Week One June 11-15th

 

 

 

Week Two June 18-22rd

 

 

 

Week Three June 25-29th

 

 

 

Week Four July 9-13th

 

 

 

Week Five July 16-20st

 

 

 

Week Six July 23-27th

 

 

 

Week Seven July 30st-Aug 3th

 

 

 

Week Eight Aug 6-10th

 

 

 

Week Nine Aug 13-17th

 

 

 

Week Ten Aug 2o-24th

 

 

 

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.


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 Signature of Parent/Guardian over age 18                 Printed Name                                Date