Register for a Class

By completing this form a $30.00 registration fee must be paid via credit card or echeck.

Please check class schedule for availabilty before enrolling your child.

Student Information

Name
Birthday		Age
Gender
Enrolled in a fall 2007 class
You must choose two differnt time slots!
Option 1 "Required"
Class
Day		Time*
Option 2 "Required"
Class
Day		Time*
Please fill out the third option to ensure availability if possible. "Optional"
Option 3
Class
Day		Time*
* For the time please enter a time according to our class schedule

Mother's Information

Name
Please enter all Phone Numbers that apply!
Work		Home
Cell		Other
Please enter your Email Address!
Email
Please enter your Mailing Address!
Address
City		State
		Zip
Employer

Father's Information

Name
Please enter all Phone Numbers that apply!
Work		Home
Cell		Other
Please enter your Email Address!
Email
Please enter your Mailing Address!
Address
City		State
		Zip
Employer

Emergency Information
-Not Parent or Guardian- Please

Name
Emergency Number
Doctor's Name
Doctor's Phone Number
Please List Known Allergies or Special Conditions

I have read all the waivers in the text box below and agree to all the terms and conditions listed there within. I realize I must sign a release form upon my child's first class meeting.
By completing this form I understand I will have to make a $30.00 payment via credit card or echeck through Pay Pal (A Pay Pal account is not required to make this payment) if not already enrolled in a fall 2007 class.

Waivers

Withdrawal Policy

I understand that if my child/children desire to discontinue class/classes at Starkville Gymnastics, Inc. I must obtain a Withdrawal Request form from the Pro Shop. This form will be dated at the time of the request and must be received, on the fifteenth day of the month prior to the month my child/children plan to attend. If notification is not received on the fifteenth day of the month prior to the drop date, I understand that I am responsible for payment of the month of my child's/children's withdrawal even though my child/children will not have attended class/classes.
I also understand that if I do not follow the proper withdrawal procedures, I will be billed and held responsible for payment of the month/months tuition fees plus finance charges (1.8% per month) until proper notification is received and accrued charges are paid.

Media Release (Optional)

On occasion, Starkville Gymnastics, Inc. is asked by newspapers, MSU personnel, etc. for permission to photograph our gymnasts. We are asking for your permission to photograph and/or video tape your child for these purposes and other Starkville Gymnastics, Inc. activities.

Release of Liability Waiver

I, (we) despite all reasonable precautions implemented for safety, am (are) fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated with participation in the programs or activities. I (we) knowingly and willingly assume all such risks. Consequently, I (we) hereby for myself, heirs, executors, and administrators, do waive and release any and all rights and claims for damages against the owner, operators, coaches, and other members of Starkville Gymnastics, Inc. from personal injury or accident of any sort or nature suffered by me (us), the undersigned, by reason of participation or membership in classes, lessons or any programs or activities of Starkville Gymnastics, Inc.

Minor Release

I, the minor's parent and/or legal guardian, understand the nature of these activities and the minor's experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releases from all liability claims, demands, losses, or damages on the minor's account caused or alleged to be caused, in whole or in part by the negligence of the "releasees" or otherwise, including negligent rescue operations. I further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claim against any of the releasees named above, I will indemnify, save, and hold harmless each of the releasees from any litigation expenses, attorney fees, loss liability, damage, or any costs that may incur as the result of any such claim.