To Enroll Your Child, Please Complete This Form and Return It to Your Daycare/Preschool

To enroll your child, please complete this form and return it to your daycare/preschool along with a check for $53.00 (includes $38.00 first month’s tuition and $15.00 annual registration fee). TINY TUMBLERS REGISTRATION FORM

Preschool/Daycare Center______

1st Child______Birth date______

2nd Child______Birth date______

Address______City______Zip Code______

Mother’s Name______Home Phone ______Work Phone______(or Legal Guardian name) Father’s Name ______Home Phone ______Work Phone______

Please list any health problems your child may have (please include allergies such as bees).______Although our tumbling program is a dynamic activity for boys and girls, it also possesses the potential for injury to the participant. At the preschool level this potential is greatly reduced, but it is still a possibility. Participants shall indemnity hold harmless “Tiny Tumblers” from any and all claims, action and causes of actions whether groundless or not, in connection with any and all injuries, losses, damages, or facility of any kind whatsoever arises, directly or indirectly, from participants in “Tiny Tumblers” activities. The “Tiny Tumblers” activities bus is designed with safety in mind. We take care to warn your child of the dangers of doing unsupervised tumbling and trying skills they are unprepared for. Undersigned agrees any photos taken of their child may be used for promotional use by Tiny Tumblers. A $25.00 fee will be charged for any returned checks. If tuition is overdue by 15 days, the student will not be allowed to participate in classes. The undersigned agrees to notify Tiny Tumblers directly (not the facility your child attends) within 14 days of your child’s last class. I (we) the undersigned do hereby consent to (our) child______participation in the “Tiny Tumblers” bus at______Preschool/Daycare Center. I (we) acknowledge that I (we) have been informed of the risks of tumbling and movement education activities.

______Date ______Parent or Guardian Signature E-mail address (optional for parents that would like a copy of our lesson plan e-mailed to them

Weekly)______

If you have any questions, please call us at (269) 692-3118 or (269) 760-9227