Registration Form

 

REGISTRATION FORM

Date:  __________            HOME PHONE_____________

Please print neatly.

E-MAIL _____________________________         WORK PHONE ____________        

STUDENT’S NAME ______________________    CELL  PHONE_____________

 

STREET ADDRESS _________________________________________________

CITY, ZIP  _____________________     CHILD DOB ___________________

 

NAME OF CLASS __________________________________________________

 

DAY________________________  TIME _____________________

 

Please list any medication your child is taking on a daily basis. ___________

_________________________________________________________________

How did you hear of Cheer Gym? ____________________________________

*Deduct 10% from tuition for 2nd child.

1st Time Registration $50    ____

Discount card $ _________

 

          Total Due:  ____              Total Pd. ____

 PARENTS NAME __________________________________________________

 PARENTS SIGNATURE _____________________________________________

Cheer Gym will only issue refunds if you withdraw from a class with 48 hours prior notice to the start of a session.

 

Please make checks payable to Cheer Gym, Inc.

Registrations received in the mail will be placed in the order they are received

Mail completed registration to

Cheer Gym, Inc.,  395 Route 9 South, West Creek , NJ 08092 

 609-296-8800

 

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Waiver and Liability Release Form

Date of Birth: __________________                  Age:     _________

Name: _______________________                  Phone: _____________________

Address: ___________________________  State:   ___       Zip Code:  ________

Emergency Contact: ______________________________  Relationship: ________________

Phone Number: ____________________Emergency Phone Number: __________________

Email_____________________________________________

In consideration of being allowed to participate in any way at Cheer Gym, Inc. athletic/ gymnastic/ sports programs, related events and activities, the undersigned acknowledges,        appreciates, and agrees that:

1.          The risk of injury form the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and

2.          I knowingly and freely assume all such risks, both known and unknown, even if   arising from the negligence of staff employees, agents, and representatives of Cheer Gym, Inc. or others and assume full responsibility for my participation or that of my minor child or ward for whom I am signing for as legal guardian of a minor; and

3.          I willingly agree to comply with the stated and customary terms and conditions for          participation. If however, I observe any unusual significant hazard during my presence or    participation, I may remove myself or a minor who I have signed for from participation and bring such to the immediate attention of nearest staff employee; and

4.          I, for myself, or my minor child/ward and on behalf of my heirs, assigned, personal     representatives and next of kin, herby release and hold harmless Cheer Gym, Inc., their officers, staff employees, agents, other participants, sponsoring agencies, sponsors, advertisers, and,  if applicable, owners and lessors of said premise used to conduct the event, (collectively the releasees”), with respect to any and all injury disability, death or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise.

5.          This is to certify that I, with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the releasees, and, for myself, any heirs,   assigns, and next of kin, I release and  agree to indemnify and hold harmless the       releasees from any and all liabilities incident to the involvement or participation of my minor child in these programs as provided above. I agree to this even if injury or death arises from the negligence of the releasees. This release is absolute and to the fullest extent permitted by law. I further certify that I have health insurance coverage on myself, or my minor child/ward, and the coverage will remaining in full force and effect during the period I, or my child/ward remains enrolled with Cheer Gym, Inc. I understand that the failure of Cheer Gym, Inc. to verify this information does not waive my responsibility to comply.

 

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND THE TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS WAIVER, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

Signature: __________________  Print:_____________________  Date: _________

 

Health Insurance Provider ________________  Policy # _______________________