Wings Gymnastics

Wings Gymnastics CLASS REGISTRATION FORM

CLASS INFORMATION

Trial Date(s) ______Registration Date ______Start Date ______

___2x/week ___1x/wk Day(s) & Time(s) ______Gymnastics Class Location ______Will you bring your child to class? ______If NO, what Classroom/Aftercare? ______How did you hear about us? ______PARTICIPANT INFORMATION Child #1 (Name & Age) ______Child #2 (Name & Age) ______Child(ren)’s Address ______City______State______Zip______Mother’s Name ______Day Phone # ______Cell Phone #______Father’s Name ______Day Phone # ______Cell Phone #______Emergency Contact______Relationship______Phone # ______MEDICAL INFORMATION Please list any allergies, medical conditions or special needs. ______

My child is, to the best of my knowledge, physically fit and able to participate in this sport. Any medical conditions or special circumstances are listed on this form (ex: asthma, allergies, recurring pain, etc…). I understand that the teacher is a trained gymnast, an experienced instructor, and is well versed in standard safety procedures and techniques. I do not hold him/her responsible for any injury that my child may incur during the course of his/her participation in gymnastics class activities. If I am not available, I authorize Wings Gymnastics and its employees to seek attention for my child and to execute orders to authorize emergency medical treatment which may be required.

______Parent or Guardian Signature Date

PAYMENT INFORMATION Resposible Party (Name): Mr./Ms./Mr & Mrs.______Address ______City ______State ______Zip ______E-mail ______Home Phone # ______

 *** Please check here if we may send your statement via e-mail

I have received, read and agree to Wings Gymnastics’ Payment and Class Policies and Procedures.

______Parent or Guardian Signature Date

Payment Enclosed? YES NO Cash $ ______Check # ______Amt $ ______* Please make checks payable to Wings Gymnastics, and return to (1) Your Lead Gymnastics instructor, (2) your school’s office, or (3) Wings Gymnastics, 3377 Prescott Cove, Memphis, TN 38111 (office address only-not the gym!)

Questions? Contact us at (901) 452-6588 or [email protected], www.wingsgymnasticsmemphis.com,