BRIGHT RAVEN GYMNASTICS
REGISTRATION FORM 2010-2011 SEASON
GYMNAST
NAME_______________________________AGE_____ BIRTH DATE____________
ADDRESS_______________________________PHONE#_______________________________
CITY__________________________________ ZIP CODE_________________
FATHER'S
NAME___________________________ MOTHER's
NAME_______________________
BUSINESS PHONE
#________________________ BUSINESS
PHONE#_____________________
Check one: New Student ___ or Last level attended at Bright Raven: Tots & Co ___ Mini Olympian ___
Girls or Boys Gymnastics ___ Tumbling Class ___ Novice Olympians ___ Pre-Team ___ USAGTeam ___
CLASS:__________________________DAY(S):__________________TIME(S):_________________
SECOND
CHOICE:_________________________________________________________________
REGISTRATION FEE: $ 25.00 DUE FROM EVERY
STUDENT IN THE BRIGHT RAVEN GYMNASTICS
PROGRAM
ONCE EACH SEASON (Season = Sept. Through August).
( only $15 if first registering for Session IV )
CLASS TUITION: $________ PLEASE
MAKE CHECKS PAYABLE TO:
BRIGHT
RAVEN GYMNASTICS, INC.
TOTAL ENCLOSED $________ P.O. BOX 24695, ROCHESTER, NEW YORK 14624
Fax:
247-0822 Circle: Visa or Master Card
#_________-_________-_________-__________ Exp. _____ -_____
REFUND POLICY:
Registration fees are non-refundable.
Tuition refunds will not be given after a session begins except to Mini
Olympians new to the program. If paying
for a session in installments, you are responsible for both installment
payments regardless of student’s actual attendance.
Is there any medical condition of which we should be
aware?(example:asthma, diabetes, hearing loss, etc.)___________
Are any medications being taken which could cause
disorientation, loss of balance, perceptual difficulties?(please list)
____________________________________________Even
over the counter products can have an effect.
Please
let us know if any are being taken, even temporarily. Thank you.
PERSON TO
CONTACT IN CASE OF EMERGENCY (OTHER THAN PARENT):
I, (we) despite all
reasonable precautions implemented for safety, am fully aware of and appreciate
the risks, including the risk of catastrophic injury, paralysis and even death,
as well as other damages and losses associated with participation in the programs
or activities. I knowingly and
willingly assume all such risks.
Consequently, I hereby for myself, heirs, executors and administrators,
do waive and release any and all rights and claims for damages against the
owner, operators, coaches and other members of Bright Raven Gymnastics, Inc.
from personal injury or accident of any sort or nature suffered by me, the
undersigned, or my child by reason of participation or membership in classes, lessons
or any activities of Bright Raven Gymnastics, Inc.
PARENT/GUARDIAN SIGNATURE________________________________________________Date___________
Please Do Not
Write Below This Line
For Office Use
Only
(In book)
Session I ( )__________________________________________________________________________
Session II ( )__________________________________________________________________________
Session III ( )__________________________________________________________________________