Registration

Your Name:
Child's Name:
Date of Birth:
Phone
Number:
Street
Address:
City:
State:
Zip
Code:
Parent's
Name:
Emergency Contact (Name & Ph #):
Session (fall, winter, etc.):
Class Type:
Day of Class:
Time of Class:
Eligible for discount? If yes, which one:
E-Mail Address:

WAIVER
AND RELEASE

NOTE: IF AN ACCEPTED ELECTRONIC WAIVER OR A SIGNED VERSION IS NOT PROVIDED
TO THE GYM, YOUR CHILD WILL NOT BE ALLOWED TO ATTEND CLASS.

 

Having been informed
and being fully aware
that gymnastics is a vigorous physical activity
that involves, but is not limited to: height, flight, rotation and twisting
in a unique environment, and

(KNOWLEDGE OF RISKS)
Further understanding that gymnastics, and gymnastics related activities always
involve certain risks, including but not limited to: death, serious neck and/or
spinal injuries resulting in complete or partial paralysis, brain damage,
and serious or minor injury to virtually all bones, joints, muscles and organs,
and

Further understanding that all the mats, pits and other equipment provided
for my child's protection, including the active participation of an instructor
who may spot or assist in the performance of certain skills, may not be able
to prevent injury,

(RELEASE)
I hereby acknowledge my understanding of the risks involved in participating
in gymnastics, and related activities, and in consideration of my child's
acceptance in the program, I agree to accept those risks for my child and
voluntarily allow them to participate.

(RELEASE FOR PHOTOGRAPHS)
I agree to allow my child's likeness to be used in promotional materials for
MarVaTots 'n Teens.

I affirm that I am of legal age, the above listed child's parent or legal
guardian, and am freely agreeing to this waiver.

 I Accept Waiver and Release I DO NOT Accept Waiver and Release – See Above NOTE and Contact Mr. Mike NOW.


 

At this point, you
can print the form with the information you have filled out or continue
with Online registration and submit the form electronically. All information
entered on this page is secure and encrypted.

Credit Card Information

We cannot guarantee your choice on-line. If there is a problem with your reservation you will be contacted by phone to identify an alternate day and/or time. You will only be contaced if there is a problem with your registration. No e-mail confirmation will be sent.

Enter the name
as it appears on the card:

Please select the credit card (VISA or MasterCard):  

Enter Your Card Number Here (No spaces):

Enter Your Card's Expiration Date Here (MM/YY): 

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