SPRING BREAK REGISTRATION

Please fill out the Emergency Information, sign the waiver

and indicate which options you are choosing for your child.

  We need a completed form for each child. Register by phone at: (301)468-9181 or fax (301)468-9129

 

 

Child’s name_______________________________________________ DOB____________________

Address_______________________________________City_______________MD______Zip_______

Home phone_________________________________

 

Parent # 1_______________________________________ cell/work phone______________________

Parent # 2_______________________________________ cell/work phone______________________

 

Emergency Contact: _______________________________ Phone: ____________________________

Food Allergies: ______________________________________________________________________



Anything we need to know? _____________________________________________________________

 

 

Day

 

9a-12 noon

 

1p – 4:00

Full Day

9a – 4:00p

Extended Day?

(am) (pm) (both)

 

Fee

Monday, April 18th

                                        

 

                       

 

 

Tuesday, April 19th

 

 

 

 

 

Wednesday, April 20th

              

 

 

 

 

Thursday, April 21st

 

 

 

 

 

Friday, April 22nd

 

 

 

 

 

TOTAL:

 

 

 

 

 

 

Only sign up for the days you are sure of - MarVaTots’nTeens has a NO REFUND POLICY.

 

Credit Card#: _____________________________________________   Exp Date: ______________

 

Having been informed and being fully aware that gymnastics is a vigorous physical activity that involves, but is not limited to: height, flight, rotation and twisting in a unique environment, and (KNOWLEDGE OF RISKS) Further understanding that gymnastics, and gymnastics related activities always involve certain risks, including but not limited to: death, serious neck and/or spinal injuries resulting in complete or partial paralysis, brain damage, and serious or minor injury to virtually all bones, joints, muscles and organs, and  Further understanding that all the mats, pits and other equipment provided for my child’s protection, including the active participation of an instructor who may spot or assist in the performance of certain skills, may not be able to prevent injury,
(RELEASE) I hereby acknowledge my understanding of the risks and voluntarily participate.

I am aware that MarVaTots’nTeens has a NO REFUND POLICY. 

I affirm that I am of legal age and am freely signing this agreement.

 

_____________________________________________                    ______________
                        Signature of Legal Guardian                                                         Date