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One-day Competitive Team Clinic for girls competing Level 1 or Xcel Bronze in the upcoming competition season.
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Event: |
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Start Date/Time: |
End Date/Time:
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Fee per Student:
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Room:
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* - denotes required fields |
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Family Information |
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Students entered below will be added to your family's account
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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Questions/Options: |
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Additional Information: |
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Assumption of Risk & Waiver of Liability
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Having been informed of the activities conducted by Champions Gymnastics Center, I, a parent or legal guardian of the minor child being registered (herein after referred to as "the participant," give my approval for the participant to participate in any and all activities of the program. I assume all risks and hazards incidental to the program including transportation to and from these activities. I further release, waive, and forever discharge any and all rights to claims against Champions Gymnastics Center, its owners, instructors, and employees, holding them harmless from any illness contracted by or injury incurred by the participant while participating in the program. Furthermore, I know of no mental or physical problems which would affect the participant's ability to safely participate in this program.
I've read the above and agree.
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Emergency Medical Authorization
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In the event of an emergency in which I cannot be contacted, I hereby authorize the directors of Champions Gymnastics Center to act on my behalf according to their best judgment in any emergency requiring medical attention, to obtain medical treatment and procedures for my child as may be appropriate in emergency circumstances including treatment by physicians, hospital and clinic personnel, and other appropriate healthcare providers. This permission begins on the first day of the program and terminates at the conclusion of the last day of the program.
I've read the above and agree.
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Permission to Photograph or Video
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I give Champions Gymnastics Center permission to photograph and/or video my child and use said photos or videos for promotional purposes only understanding that Champions will not identify my child by name when doing so. Furthermore, I also understand that the name of the gymnastics facility at which my child practices may be named.
I've read the above and agree.
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Permission to Give Tylenol or Ibuprofen
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I give Champions Gymnastics Center permission to give my child an age/weight appropriate dosage of an over the counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Motrin).
I've read the above and agree.
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Other Questions/Comments: |
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Nickname:
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Card Expiration Month: * |
Exp Year: *
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Address Line 1:
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Address Line 2:
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City:
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State:
Zip:*
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| eCheck/Bank Draft:
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Bank Name: |
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Bank Routing Number: |
(9-digit number)
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Your Account Name: |
(Your name on your bank statement)
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Your Account Type: |
Account Number:
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