Class Day & Time______Start Date ____/____/____ In District □ Out of District □ River Road Park’s Gymnastics Northwest Registration Form Student & Family Information (please print) Gender Student 1______M / F Age_____Birth date____/____/____

Student 2______M / F Age_____Birth date____/____/____

Student 3______M / F Age_____Birth date____/____/____

Parent / Guardian Name(s)______

Address______City______Zip______

Home Phone______E- Mail______

Mother’s Cell______Father’s Cell______

Parent/Guardian Work Phone______Company______Ext_____

School Name______Grade______

Emergency Information (Who to call if parents cannot be reached)

1. Name & Relation______Phone______

2. Name & Relation______Phone______

Physician’s Name______Phone______

Pertinent Medical Conditions (Allergies, impaired vision, physical restrictions, previous injuries, etc.): ______

Insurance Company & Policy #:______Authorization for Medical Treatment Authorization is hereby granted to River Road Park and Recreation District to provide for first aid emergency medical care for ______(Participant=s Name) during such time that said student is participating in park and recreation district activities. This care may be given under whatever conditions necessary to preserve the limb, life, or well being of student. It is agreed that the park and recreation district will not become responsible for any financial liabilities incurred in the provision of medical care. I understand the fee for this program does not include accident insurance coverage.

Participant or Parent/Guardian Signature______Date______

Please complete back page Revised 9/5/2013 RIVER ROAD PARK’S GYMNASTICS NORTHWEST POLICIES Please read and sign ______Student’s Name 1. Classes are ongoing and run on a monthly basis. You may join at any time. Tuition is due the first (1st) of every month payable to River Road Park’s Gymnastics. Your account must be paid up-to-date before continuing to the next month. One month past due accounts will result in your student being dropped from class. If your account becomes overdue, you will receive a letter or phone call asking you to bring your account current within 7 days. Student can continue once account is current.

2. A one-time $20 registration fee (per family) for all new and returning students (excluding private lessons, birthday parties, open gyms, martial arts, and camps) will be charged beginning with your first class. One (1) month’s notice is required to drop out of class and have the registration fee applied to your last month’s tuition. Failure to notify 1 month in advance results in loss of registration fee. Please notify the gym office if you plan on dropping a class at least 1 month in advance. Forfeiture of registration fee will result without 1 month notice.

3. Please notify the gym office if your child will be absent. Missed classes will not be prorated, deducted from tuition, or made up. If your child is unexcused for two consecutive weeks, they could be dropped from class. Your child’s tuition is based on an annual fee divided monthly; therefore, your monthly payment will be the same during those months that are longer, have holidays, vacations, etc.

4. New students who begin after the first week will have their tuition prorated. Only if you notify the office in advance, vacations of two weeks or more will be prorated by half. A family discount of 10% is given if 2 or more students are from the same family. Please contact the gym office and they will calculate your monthly fee for you.

5. A student’s spot in class can only be held by current participation. We are unable to hold a spot for your child. If you plan to temporarily drop a class for a month or more, you must re-register upon your return – the student may be placed on a waiting list for that class.

6. Payments for current students can be made at the park district office or placed in the tuition box at the gym. New students must register at gym office. Be sure to include the student’s name and class title with the payment. Accident insurance is not provided for this activity. All students must have on file a completed registration form. New students should fill out a form on the first day of class and return it to the gym office. Any changes, IE. address, phone, emergency contact, should be submitted on a new form or updated personally at the gym office. We would be happy to assist you in finding the right class for your child.

7. Participant acknowledges that River Road Park District may use photographs of participants in district publicity without permission or compensation. Payment of fees and participation in the activities shall constitute acceptance of this liability and photography release. □ I do not wish to have my child photographed.

8. Warning of Inherent Risks: Any activity involving motion, height, or physical contact with another student creates the possibility of accidental injury. Gymnastics equipment is intended for use ONLY by properly trained and qualified participants under supervised conditions. Use without proper supervision could be DANGEROUS and should NOT be undertaken.

I am aware that participating in gymnastics is a potentially hazardous activity. I assume all risks associated with participation in this sport, including but not limited to falls, contact with other participants, and other reasonable risk conditions associated with the sport. All such risks to me or my child are known and understood by me.

I hereby release, indemnify and hold harmless the District, its directors, employees, and agents from any injury, whether to person or property, of the participant resulting from such activities. In case of personal injury to participant, I hereby waive any and all claims against the District, its directors, employees and agents.

By signing below, I acknowledge I have read, understand, and agree to the policies listed above.

______Participant or Parent / Guardian Signature Date

Please complete both pages