Please complete this form and return along with your annual registration fee of $30.00
Parent Information:
Mother:
Mother's Cellphone:
Father:
Father's Cellphone:
Email:
Home Phone:
Emergency Contact
Emergency Contact Relationship
Emergency Contact Phone
Student Information:
Last Name:
First Name:
Date of Birth:
Gender:
School:
Home Address:
City:
State:
Zip Code:
Family Doctor
Dr. Phone:
Dr. Office City:
Medical Conditions, if any:
MEDICAL RELEASE OF LIABILITY AGREEMENT
Any activity involving motion or height creates the possibility of serious injury, including permanent paralysis and death from landing or falling on the head or neck. Gymnastics is accomplishing certain bodily movements and rotations while in the air or using specific gymnastics apparatus. Artistic Gymnastics, Tumbling, Trampoline, Cheerleading, and Acrobatic Gymnastics all include skills associated with landing that can involve risks from minor injuries to catastrophic or life threatening injuries. No amount of instruction, spotting, or mats can guarantee safety. I, ,(parent, or guardian) have read and fully understand the above warning paragraph. I hereby give my permission for the above named student to participate in one or more of the gymnastics, acrobatics, cheerleading, tumbling & trampoline, or competitive-training programs at Realis Gymnastics Academy and I assume the responsibility for any serious or catastrophic injuries.
In consideration for allowing my child to use the Realis Gymnastics Academy facilities, I hereby forever release Realis Gymnastics Academy and its staff, directors, and/or any parent from any responsibility in case of accident, illness, or injury during his/her enrollment in Realis Gymnastics Academy. I understand that I am responsible for any medical expenses that may be incurred through my child’s participation in any program at Realis Gymnastics Academy.
I give permission for my child’s photograph to be taken and used at the discretion of Realis Gymnastics Academy for publicity or professional purposes to reward the student’s participation.
I have read all of the above WARNINGS AND RELEASE STATEMENT and agree to allow my child to participate at Realis Gymnastics Academy
Parent/Guardian Signature
Where did you hear about us?
Student Name:
Please Initial Each Box REALIS GYMNASTICS ACADEMY Rules & Regulations
1. BILLING INFORMATION. We require all families to have a valid credit card on file. You can enter and save your card details on our Parent Portal, or provide your card information to the front desk. TUITION is billed monthly and we will automatically charge the credit card on file on the FIRST DAY OF EACH MONTH. If your automatic payment fails for any reason, you will be contacted via email and payment will need to be made by the 7th or a $15.00 late fee will be added to your account. If tuition is not paid by the 7th your child will not be able to attend class and will be dropped from their class on the 10th until your account is current. If space in the class is no longer available, you are still responsible for payment, due to insufficient notice.
You can still pay by cash or with a different credit card as long as payment is made before the first of the month. If your credit card transaction results in a “charge back,” you will be charged $35.00.
Annual Registration fee is $30.00 per child. Initial:
2. MAKE-UP DAYS are offered on the last Saturday of each month. Your athlete must miss his/her regular class prior to scheduling a makeup. You are allowed ONE (1) make up per month regardless of the number of classes enrolled in. There are no refunds or credits for missed classes due to Holidays, Canceled Classes, or unforeseen Closures; nor do they constitute a make-up day. RGA reserves the right to cancel any class at any time. Initial:
3. DROPPING A CLASS is permitted only with a WRITTEN NOTE delivered to the office (phone calls, mailing a letter, emailing without prior consent, or telling a coach is not sufficient notice). A Drop Notice must be received 15 days prior to the 1st of the month that you intend on dropping or you will be obligated to pay that month’s tuition. Please note that dropping class does not reserve your class. Initial:
4. CHANGE OF CLASS TIMES: Athletes must stay in the class they are enrolled in but may request to move times and/or coaches at the end of the month, prior to the new billing cycle. If you are adding a class to your schedule, you may do that at any time during the month and class tuition will be prorated. Initial:
5. Parents, siblings and visitors are not allowed on the gym floor unless you are enrolled in a Parent & Me class. The observation lobby is available at all times for your convenience. There must be a parent with siblings or children at all times in the observation area. Initial:
6. Students must be prompt for their classes! Warm-ups are extremely important, and it can be upsetting to the late child as well as disruptive to the class when children enter late. IF THE STUDENT IS OVER 15 MINUTES LATE, THEY WILL BE SENT TO THE FRONT DESK TO SCHEDULE A MAKEUP. Initial:
7. Students must wear proper clothing. Leotards, t-shirts, shorts, anything without buttons, or zippers. NO jeans, tights, belly shirts, sports bras or socks, please. Do not wear rings, bracelets, watches, necklaces or long earrings. Anything that dangles could create a safety issue. Long hair must be pulled back and tied securely during class. Initial:
8. Students are not allowed on the equipment before or after class. Initial:
9. Absolutely no food or drinks allowed on the gym floor, only water bottles. No chewing gum during class. Initial:
10. Once the students enter the facility, they should leave their belongings with their parents and wait for their classes to begin in the observation lobby. Parents are responsible for their children until the start of class and immediately following class. Initial:
11. Any student who misbehaves during class or training will be asked to sit down in a time-out. If the situation continues, a parent will be notified to assist in determining whether or not the child should continue in class. We teach from a positive approach, but cannot tolerate potentially dangerous behavioral situations. Initial:
Parent/Guardian Name:
Signature:
Date:
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