American Twisters Online Registration

Registration

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* denotes required fields

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 #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Enroll in Classes

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*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Enroll in Classes

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*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Enroll in Classes

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*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Enroll in Classes

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*

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Enroll in Classes

Add Another Student

Required Policies and Agreements

Policy Acknowledgement Agreement

I have read completely and understand the policies and procedures of American Twisters or ICT and agree to abide by such, including by not limited to payment of all fees owed and proper notice of intent to quit. I understand that should these policies change or be updated, I will be given a copy of the new policies and procedures and will adhere to those as requested.

I've read the above and agree.

Athletes Release

Participants, in attending the gym and using the facilities, does so at his/her own risk. They gym operator shall not be liable for any damage arising from personal injuries sustained by participant in or about the premises. Participant assumes full responsibility for any and all injuries and damages which may occur in or about the premises and he/she does hereby fully and forever release and discharge gym operator, all associated gyms, their owners, employees and agents from all claims, demands, damages, rights of action, present or future, resulting from or arising out of participant's use of the gym and/or its facilities. Participation is entirely his or her own choice and with the understanding of risk of accidental injury or death in any activity involving unusual motion or height.

I've read the above and agree.

Permission for Medical Treatment

In the event of an emergency requiring medical attention, I hereby grant permission to a physician or other hospital personnel designated by American Twisters or ICT staff to attend to my child.

I've read the above and agree.

Acknowledgment of Risk and Liability

I hereby consent to the above person(s) participating in the American Twisters or ICT programs, I recognize that potentially severe injuries including but not limited to permanent paralysis or even death can occur in any activity involving height, motion, or impact including gymnastics. I also realize that my child(ren) will be performing and training on all gymnastics events plus various training devices. I understand that it is the express intent of American Twisters or ICT to provide for the reasonable safety and protection of me/my child(ren) and in consideration for allowing me/my child(ren) to use these facilities, I hereby for myself, heirs, executors and administrators, forever release American Twisters or ICT, its officers, employees, teachers, and coaches all liabilities for any and all damages and injuries suffered by me/my child(ren) while under the instruction, supervision, or control of American Twisters or ICT. I also certify that me/my child(ren) is/are and will remain covered by an Adequate Accident insurance Program covering me/my child(ren)'s participation in American Twisters or ICT. As legal guardian of the aforementioned person(s), I hereby agree to individually provide for the possible future medical expenses, which may be incurred by me/my child(ren) as a result of any injury sustained while training at or performing for American Twisters or ICT.

I've read the above and agree.

Attendance Policy

Attending class regularly is the responsibility of the parent and athlete. You may attend open gym as a courtesy we offer to our customer.

I've read the above and agree.

Permission for Video and Photographic use for each athlete:

I hereby give my permission for any video or photographs taken of my child during any activity in which American Twisters is
hosting to be used for any advertising or as seen fit by the staff of American Twisters/ICT.

I've read the above and agree.

Payment Record and Agreement

I agree to pay all monthly tuition payments/season fees and registration fees in consideration for instruction provided by American
Twisters or ICT. In the event that this account becomes delinquent and collection activity becomes necessary, I understand that I
will be responsible for any and all attorney fees/court costs or any other monetary fees associated with the collection of the monies
owed for my account. I understand that there is a $35.00 registration fee due yearly which is discounted to $15.00 for a sibling and
will be due each year on August 1st. Monthly tuition is due on the 1st of each month and is considered late after the 15th day in which a $30.00 late fee is then added. All classes must be paid for regardless of attendance and in the event that I wish to withdraw membership, I must provide a written 30-day notice. There will be no refunds for an uncompleted tuition and/or season
fees.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

Membership Type

Please fill out ONE of the following Payment Methods

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number