SUMMER
2008:
SUMMER REGISTRATION
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.
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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Week |
Option |
Extend Day(yes/no) |
Fee |
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Week 1 - 6/16 - 6/20 |
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Week 2 - 6/23 - 6/27 |
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Week 3 - 6/30 - 7/3 (closed 7/4) |
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Week 4 - 7/7 - 7/11 |
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Week 5 - 7/14 - 7/18 |
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Week 6 - 7/21 – 7/25 |
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Week 7 - 7/28 - 8/1 |
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Week 8 - 8/4 - 8/8 |
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Week 9 - 8/11 - 8/15 |
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Week 10 - 8/18 - 8/22 |
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TOTAL: |
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We accept cash,
checks, MasterCard and Visa. Only sign up for weeks you are sure of,
MarVaTots’nTeens has a NO REFUND POLICY.
Credit Card:
MasterCard/Visa CC#:
_______________________________ 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