Registration

Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info
 
 
Students entered below will be added to your family's account
 
Questions/Options:
I will make full payment by 3/8/19 to receive the discounted camp rate of $250 I understand that my credit card will automatically be charged on 3/8/19 if I haven't made a full payment by 3/8/19*
Add before and after care. $75 weekly*
Add before and after care. $20/day*
Monday ( 8:00 am - 10:00 am / 4:00 pm - 6:00 pm ) (checked=yes)
Tuesday ( 8:00 am - 10:00 am / 4:00 pm - 6:00 pm ) (checked=yes)
Wednesday ( 8:00 am - 10:00 am / 4:00 pm - 6:00 pm ) (checked=yes)
Thursday ( 8:00 am - 10:00 am / 4:00 pm - 6:00 pm ) (checked=yes)
Friday ( 8:00 am - 10:00 am / 4:00 pm - 6:00 pm ) (checked=yes)
Allergies/Medications:
 
Additional Information:
 
Payment
$100.00 non-refundable deposit will secure your child’s spot.
Register by 3/8/2019 - $250. Full payment due 3/8/19 to secure discounted rate.
Register by 3/22/2019 - $275. Full payment due 3/22/19 to secure discounted rate.
Register 3/23/19 or later - $325. Full payment due at the time of registration.

I've read the above and agree.
 
Assumption of Risk
I am 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 a gymnastics program. I further agree that Alpha Gymnastics and Evergreen Athletics LLC, along with its employees, agents, officers, and directors, shall not be liable for any losses, expenses, or damages occurring as a result of participation in the program and/or activities or event except where such loss or damage is the result or the intentional or reckless conduct of one of the groups or individuals identified above.
I've read the above and agree.
 
Release of Liability
The undersigned, being duly aware of the risks and hazards inherent upon participation in the classes, activities, and events being conducted by Alpha Gymnastics/Evergreen Athletics LLC, acting for themselves and the student, hereby elect voluntarily to enter upon the said premises under the control of said corporation, knowing the present condition. The undersigned, acting for themselves and the student, hereby voluntarily assume all risks of loss, damage, or injury that may be sustained by the student while in said premises described above.
I've read the above and agree.
 
Medical Emergencies
In the event of any incident which may require immediate medical/dental or any other emergency attention/care in which the Legal Guardians cannot be notified in a reasonable time through reasonable means, the undersigned hereby authorizes Alpha/Evergreen Athletics to take all necessary actions as it relates to immediate medical/training attention, transportation, and emergency medical services as warranted in the course of care of the undersigned student. The undersigned is aware that they will be responsible for all fees and expense as they may relate to this medical attention paragraph.
I've read the above and agree.
 
Marketing and Promotional Release
I also understand that there may be occasions that photos or videos are taken of the activities that my family members participate in and that these digital images are the sole property of Alpha Gymnastics and Evergreen Athletics L.LC. I agree to allow Alpha Gymnastics to use these digital images as they see fit for marketing and promotional purposes. I also understand that through my Alpha Gymnastics membership, I will receive email communications in regards to classes, payments, promotions, events and other marketing announcements. PRIVACY NOTICE: It is the policy of Alpha Gymnastics and Evergreen Athletics L.L.C. to NOT sell or distribute members' information to any third party.
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*