Class Registration Signup Form

Student Name

First Name Middle Name Last Name

Birth Date

Month Day Year

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mobile Number

- Area Code Phone Number

Mother's Name

First Name Last Name

Mother's Occupation

Mother's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Phone Number

- Area Code Phone Number

Mother's Email

example@example.com

Father's Name

First Name Last Name

Father's Occupation

Father's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Phone Number

First Name Last Name

Father's Email

example@example.com

Additional Comments

Person Responsible for the Account (must be at least 18 years of age.)

Name

First Name Last Name

Phone Number

- Area Code Phone Number

Relationship

Signature (By entering your name, you agree to be personally responsible for this account)

Emergency Contact (other than parent)

First Name Last Name

Relationship

Doctor

First Name Last Name

Phone Number

- Area Code Phone Number

Special Medical Conditions

Allergies

Medical Insurance

Previous Experience

How did you hear about MBS Gymnastics Academy?

You have my permission to give my contact information to other class members.

Yes No

We follow Horry County School closings. If they are closed, then MBS Gymnastics is closed. Note: Competition teams still may work out.

I understand.

A non-refundable $25 registration fee per person will be charged and covers registration through August 2018.

Agree

A one month tuition deposit will be due at time of registration. This will cover the last month (May) tuition. Summer should be paid in full by no later than July the 15th.

Agree

Tuition payments will be charged on the 1st of each month. Tuition is based on a yearly schedule, not per class, therefore monthly tuition is the same, regardless of the number of classes in a given month. You may choose to pay the year's tuition and one complete payment or divided into monthly payments. There are NO REFUNDS for any reason.

I understand.

Costume / uniform money is non-refundable, and will be held if tuition payments are not current.

I understand.

There will be a $30 charge on all insufficient funds and a late fee will apply.

I understand.

MBS Gymnastics reserves the right to release any child from our program, at coaches discretion, due to behavioral problems or lack of listening skills, which are safety issues, as well as, but not limited to, tardiness or non-payment of tuition. It is a privilege to work out at MBS gymnastics.

I understand.

No credits or refunds will be given for any reason. This includes absences. We do not do make-ups.

I understand.

A 30-day written notice is required on all withdrawals. Failure to give notice will result in loss of monthly deposit and class spots will be forfeited. Phone messages will not be sufficient. Tuition will continue to be due until written notice is signed for by Erin. Once 30-day written notice is received, we will apply your last month's tuition to the next due month. Last month's deposit cannot be transferred to December.

I understand.

When you enroll in weekly summer sessions, you are committing to enroll for the entire summer. No exceptions. Summer tuition must be paid in full by no later than July 15th.

I understand.

Private lessons must do a minimum of one 30 minute private lesson per month or repay the $25 registration fee.

I understand.

By selecting "I understand" I give my permission for MBS Gymnastics to use my child's picture / video in any form, for advertising / and or social media purposes.

I understand.

I hereby give my permission to MBS Gymnastics staff and trained medical professionals to administer emergency medical treatment to my child should sickness or accident occur in my absence.

Permission Granted.

As legal guardian of registered child, I hereby consent to the aforementioned person participating in any of the MBS Gymnastics programs. I recognize that potentially severe injuries, including permanent paralysis or death can occur in any activity involving height or motion, including gymnastics, dance, cheerleading and related activities, including tumbling and trampoline. I have spoken to my child about these risks. I understand that is the express intent of MBS Gymnastics to provide for the safety and protection of my child and, in consideration for allowing my child to use these facilities, I hereby forever release MBS Gymnastics, it's officers, employees, teachers, and coaches, from all liability for any and all damages and injuries suffered by my child while under the instruction, supervision, or control of MBS Gymnastics. As legal guardian of the aforementioned person, I hereby agree to individually provide for the possible future medical expenses which may be incurred by my child as a result of any injuries sustained while training at, or performing for, MBS Gymnastics.

I understand.

I understand and acknowledge that my child is not insured at MBS Gymnastics Academy and I take full responsibility for anything that may happen while at MBS Gymnastics or while participating in any of our activities or programs. I have read and understand the risks involved. This acknowledgement of risk and waiver of liability, having been read thoroughly and understand completely, is signed voluntarily as to its content and intent. By selecting "I agree," you agree to all the terms and conditions of this form.

I agree.

Student Registration Form