Parent's Full Name (required)

Child's Full Name (required)

Child's Date of Birth (required)

Child's Age:

Child's Gender:

Phone

Address

City

State

Zip Code

Your Email (required)

I will pay tuition by the 1st of each month for the current month regardless if I receive a
statement. A $15 late fee will be charged after a 5-day grace period. I also understand that
failure to pay by the 15th of the month will also result in a $50 re-registration fee before my child
may continue in any activity.

- I understand that every student must pay an initial enrollment fee of $50 and on each anniversary
date of their initial enrollment a $25 fee must be paid for the student to continue, due to the
liability factor.

- I understand that there will be a $20 charge for any check that is returned, regardless of the
reason.

- I acknowledge that potentially severe injuries may occur in any activity involving height or
motion, and it is the express intent of the owner and/or staff to provide for the safety and
protection of its participants. Should sickness or injury occur, I hereby give my permission for
trained medical professionals to be notified immediately and to administer emergency medical
treatment, if deemed necessary, to the above named student. In consideration for permitting the
above named student to participate in activities, I hereby release the owner and staff from all
liability and for any and all damages resulting from injuries suffered by the above named student
while under the instruction, supervision of said owner and staff.

I have read the statements above, as well as read and understand the “Gym Policies” sheet
(separate sheet; pdf on Enrollment Tab) and by signing below I hereby agree to comply with both:

Type Name Here:

Sign Here: