Aim High Gymnastics Registration
Student Information
___________________________________ _________________________/____/____
Student’s Name
Birth Date
______________________________________________________________________
Address
City
Zip
Mother’s Name ___________________________ Phone ____________________ ____
Father’s Name ____________________________Phone ____________________ ____
Emergency Contact:
Name___________________________Relation___________Phone________________
How did you hear about Us? ________________________________________________
Family email address______________________________________________________
Are there any medical or developmental concerns that would help us serve your child better? Please Describe.
_____________________________
Class Information
1st Class Name ________________________Day _______________ Time ____________
2nd Class Name________________________Day _______________ Time ____________
Session: I II III
IV V
ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY
THE ABOVE REGISTRANT (HIS/HER LEGAL GUARDIAN OR PARENT IF UNDER
THE AGE OF EIGHTEEN) AGREES TO INDEMNIFY AND HOLD HARMLESS AIM HIGH GYMNASTICS, INC. ITS OFFICER MEMBERS, AGENTS AND COACHES/INSTRUCTORS
AGAINST ALL LIABILITY, CLAIMS, DAMAGES, LOSSES, AND EXPENSES, INCLUDING ATTORNEY FEES, ARISING FROM THE REGISTRANTS PARTICIPATION
OR BY REASON OF ANY INJURY OR ANY DAMAGES TO ANY PERSON OR PROPERTY OCCURRING DURING SAID PARTICIPATION, OR FROM ANY CAUSE
WHATSOVER. I/WE FULLY REALIZE THAT GYMNASTICS CAN BE A DANGEROUS SPORT THAT COULD RESULT IN SERIOUS INJURY OR POSSIBLY DEATH.
AGREED: PARENTS/GUARDIAN______________________________DATE:_____________
Payment Information
Annual Registration Fee& $20/$25.00 Family……. …………………………………………
$ ____________
Tuition (full payment required) ………………………………………… $____________
TOTAL ENCLOSED
……………………………………………………………………………… $_____________
Payment Type:
Check #______________________Credit Card__________Cash____________
