Arcadia Gymnastics Center

243 Elmbrook Road, Beaver Falls, PA  15010

451 Constitution Blvd, New Brighton, PA  15066

 

2020-2021 Registration Form

 

Family Information / Parent / Guardian / Billing Contact

 

Registration Fee:                $35 per Child / $75 Maximum per Family

 

 

Parent/Guardian Name: ______________________________________________________

 

Address: __________________________________________________________________

 

City:__________________________________State:______________Zip:______________

 

Home Phone: __________________________Cell:_________________________________ 

 

E-Mail:_____________________________________________________________________

 

Emergency Phone:___________________________________________________________

 

Medical Insurance (Company & Policy #)___________________________________

 

 

Student Information

 

 

1st Student Name: _________________________________________________ Birthday:___________________

 

Class:______________________________________Day:_____________________Time:____________________

 

Medical Conditions/Allergies:____________________________________________________________________

 

 

 

2nd Student Name: _______________________________________________ Birthday:____________________

 

Class:______________________________________Day:_____________________Time:____________________

 

Medical Condition/Allergies:_____________________________________________________________________

 

 

 

3rd Student Name: _________________________________________________ Birthday:___________________

 

Class:_______________________________________Day:_____________________Time:____________________

 

Medical Condition/Allergies:_____________________________________________________________________

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________(initial) ASSUMPTION OF RISK, WAIVER OF LIABILITY As self or legal guardian of the above named persons, I recognize that potentially severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, including but not limited to gymnastics, tumbling, ninja, cheerleading, camps, private lessons, birthday parties, bring a friend, open gym,  and field trips.  In signing my name to this waiver I admit that I know full well the potential for injury which can occur in gymnastics, cheerleading, ninja and fitness activities. I understand that my participation is entirely by my own choice and with the understanding of risk of accidental injuries involving unusual motion or height. I realize that every safety precaution is enforced and that injuries may still occur.  I am aware of the rules and regulations in the gym.  I also understand that participation may result in possible exposure to and illness from infectious diseases, including, but not limited to, MRSA, Influenza and Covid-19.  While particular rules and personal discipline may reduce this risk, a risk of serious illness and death does exist.  I knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for my participation and exposure. 

 

If student is a minor, it is acknowledged that the parents or legal guardian know of this activity, and will sign acknowledging the injury risk the child is assuming. Being fully aware of these dangers, I voluntarily consent to the aforementioned persons participating in any and all programs at either of the Arcadia Gymnastics locations and I ACCEPT ALL RISKS associated with that participation. In consideration for allowing my child to use this facility, I, on my own behalf and the behalf of my child and our respective heirs, administrators, executors, and successors, hereby COVENENT NOT TO SUE and FOREVER RELEASE Arcadia Gymnastics, its officers, directors, shareholders, employees or other representatives, whether paid or volunteer, from all liability for any and all damages or injuries suffered by my child while under the instruction, supervision or control of Arcadia Gymnastics. I also understand that it is the parent’s responsibility to warn the child about the dangers of injury. The parent should warn the child according to what the parent feels is appropriate. Arcadia Gymnastics will warn the child thru Safety Messages and our teaching style and progressions. I also understand and give permission for photographs and videos of my child to be used in print or broadcast media as deemed appropriate for the promotion of Arcadia Gymnastics.

 

________(initial) PERMISSION FOR EMERGENCY MEDICAL TREATMENT/MEDICAL INSURANCE I confirm that my child is in good health and I have medical insurance on my child and will provide coverage while he/she is enrolled. I fully understand that Arcadia Gymnastics staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release Arcadia Gymnastics staff members to render temporary first aid to my child in the event of any injury or illness, and if deemed necessary by the Arcadia Gymnastics Staff to seek medical help including calling of an ambulance for said child. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by my child as a result of any injury sustained while participating at Arcadia Gymnastics.

 

________(initial)TUITION PAYMENT, ENROLLMENT AND BILLING INFORMATION I understand that my child is enrolled in an 8 week program. Arcadia Gymnastics will not automatically assume that my child will continue into the next term, unless I am registered in Auto Billing or have pre-paid for the next term. Class goals and progressions follow the school year so I should re-enroll bimonthly.

 

__________(initial) If I drop a class after the term begins, I WILL NOT receive credits and/or refunds for the remaining classes in that term. I understand that Arcadia Gymnastics does not give credit and/or refunds for, but not limited to programs, class (es), clinics, camps, private lessons, missed and/or cancelled due to holidays, vacation, illness, weather related or any other reason.  Arcadia Gymnasticsdoes offer one make up classes for each term.  Make up classes must be registered for in advance by stopping by or calling the Arcadia Gymnastics locations.

  

__________(initial) I must pay Arcadia Gymnastics prior to the PDD date in order for my child’s spot to be reserved in class. 

 

The following are payment options:You may pay by check, cash or credit card in the office.  If you pay online there is a 4% service fee for each transaction.

 

You may enroll in Auto Billing in which your credit card will be charged every PDD of each term.  You will be assessed a 4% service fee for each transaction. You must supply the actual credit card to the office personnel or go online and place the card number on your account.  Arcadia Gymnastics will not accept credit card numbers via the telephone. You must cancel with the office prior to the PDD if you wish to discontinue your auto billing or a $20 service fee will be assessed if you desire a refund.  

 

 

*All enrolled students will be charged an annual registration fee of $35 each for a maximum of $75 per family.

*Arcadia Gymnastics reserves the right to modify the terms of this agreement with written notice.  

*All returned checks will incur a return check fee of $35.  

*All credit cards that are automatically charged for the purpose of AutoTuition will incur a $35 fee if the card is declined for any reason.

 

 

 

I agree to all of the above terms and conditions of Arcadia Gymnastics.

 

 

 

Signature: _________________________________________________Date_________