Evolution Training Center Online Registration

Registration

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Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

I acknowledge and understand that due to the nature of this activity,
which involves inversion and rotation of the body, there is a possibility that my daughter/son may sustain physical illness or injury (minimal, serious,
or catastrophic), in connection with her or his participation. I further acknowledge and understand that my daughter/son is assuming the risk of such
illness or injury through her/his participation.

I've read the above and agree.

Release of Liability

I release Evolution Training Center, LLC, and its staff, agents, employees and
representatives and Evolution All Stars, Inc. from any and all claims for personal illness or injury that my daughter/son may sustain during
participation in said activities. I further understand that Evolution Training Center, LLC and Evolution All Stars, Inc. has established rules and
regulations pertaining to conduct, behavior and activities of all students and cheerleading participants, by which my daughter/son must abide during
participation in said activities, and that my daughter/son and I will be responsible for her/his failure to abide by those rules and regulations. I further
grant permission to ETC and EAS to photograph my daughter/son during the aforementioned activities for use in publications and advertisements to
promote ETC, EAS and affiliated companies.
ACTIVITY DESCRIPTION: CHEERLEADING AND TUMBLING ATHLETICS including but not limited to tumbling, stunting, jumping,
cheerleading, dancing, conditioning and related exercises/ physical activities. Instruction can be done in a camp, clinic, class or team
practice setting.

I've read the above and agree.

Payment Policies

All Payments must be made before services are rendered. I understand that a $50 insurance/ registration fee for an individual student or $95.00 for a family registration/ insurance fee is due annually and will be posted to my account on the initial start date and subsequent aniversary date of enrollment. I understand that upon submitting this form, my athlete is enrolled in this payment program. Evolution Training Center, LLC (ETC) will make best business efforts to charge all monthly tuition rates by the 1st of every month but reserve the right to charge the agreed upon tuition rate anytime during the month. The authorization will bill on a month-to month rollover basis until the contracted service period ends or until a written cancellation request is received by Evolution Training Center, LLC. This cancellation notice must be received by the 20th of the month preceding the date of withdrawal from a class or program. Personal credit card orbanking information is confidential and will not be available to anyone for any other reason.

I've read the above and agree.

Make Up Policy

I understand that all absences require a 24 hour cancellation notice and that the make-up must be taken within a month from the missed class. If class attendance falls below 4 members a 60 minute class will be reduced to 45 minutes and a 90 minute class will be reduced to 75 minutes. Evolution Training Center, LLC/ Evolution All Stars, Inc. must be notified by the 20th of the preceding month if you or your child is planning to withdraw from a class or program. Failure to comply with this policy will result in a monthly tuition charge for that month. All agreements signed for team members of Evolution All Stars, Inc. will remain in effect. Evolution Training Center does not offer refunds on tumbling classes or deposits for birthday parties and other events. If your child needs to miss a class that you have already paid for, please contact the front desk and we will schedule a make up class. Class must be paid for prior to the start of the class.

I've read the above and agree.

Private Lesson Policies

I agree to the private lesson policies as outlined on the "Private Lesson Policies" form at http://theevolutiongym.com/classes/private-lessons/.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

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Payment Information

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