Please fill out the Emergency
Information, sign the waiver and indicate which option you are
choosing for your child and which weeks.
We need a form for each child you are registering.
Your child will not be allowed to
participate if we do not have all the required information and signatures. We
accept cash, checks, MasterCard and Visa.
Only sign up for days you are sure of, MarVaTots�nTeens has a NO REFUND POLICY.
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_____________________________________________________________
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9am-12noon |
1pm- 4pm |
Full Day 9am-4pm |
Extended
Day? (am)(pm)(both) |
Fee |
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Full week |
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Mon. 3/29 |
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Tues.
3/30 |
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Wed. 3/31 |
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Thurs.
4/1 |
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Fri. 4/2 |
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Total: |
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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