Green Mountain Gymnastics, Inc.
240 Pioneer Drive, Williston, VT 05495
802-652-2454
2008 Summer Camp Registration Form

Child's name:


 DOB:


Age:


   Male
  Female
Street:


 City:


ZIP:


Parents/Custodial parent or legal guardians:


Phone Numbers Home Work Cell
Parent

    
Spouse/Partner

    
Email address:

(GMG may use this for informing parents of class changes or any upcoming events)
Person responsible for the payment on this account:


Street:

 City:

ZIP:

Home phone:

 Work phone:

Cell phone:

 Email:

Doctor's Name:

 Doctor's phone #:
In case of emergency, please call: Phone Relationship
Name:

   
Name:

   
PLEASE INFORM US OF ANY MEDICAL CONDITIONS OR ALLERGIES





Please continue on page 2


Office use only:
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PIF:


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Green Mountain Gymnastics, Inc.
Summer Camp 2008 Registration Form (cont.)

Please circle session attending & mark appropriate rate
SessionDates Rate
  Tiny Flips (Ages 4-6)
TF1Tiny Flips Camp sesson 1 June 16 - June 20 (8:30-11:30)$115 
TF2Tiny Flips Camp sesson 2 July 21 - July 25 (8:30-11:30)$115 
  Summer Flips (Ages 6 and above)
SF1Summer Flips session 1June 23 - June 27 $115 
SF2Summer Flips session 2June 30 - July 2 (3 days) $70 
SF3Summer Flips session 3July 7 - July 11 $115 
SF4Summer Flips session 4July 14 - July 18 $115 
SF5Summer Flips session 5July 28 - Aug 1 $115 
SF6Summer Flips session 6Aug 4 - Aug 8 $115 
SF7Summer Flips session 7Aug 11 - Aug 15 $115 

Total Due

  
Next 2 rows for GMG use only
Deposit Paid
Non-refundable deposit of $50 required for each session attending
must be paid with registration		 Date:


 Amount:
Balance Due
Must be paid in full 7 days
prior to start of each session		 Amount:


 Date paid:

Transportation to the Sports & Fitness Edge
If attending Camp Edge afternoon program - please indicate below what days you will need us to provide transportation to the Sports & Fitness Edge.

Mon ______ Tues ______ Wed ______ Thur ______ Fri ______

Cancellation policy
  • The $50.00 deposit is non refundable.

  • If payments are made in full for a camp and a cancellation is made within a 30-day notice, a full refund will be made minus the $50.00 non-refundable deposit.

  • Cancellations made with notice less then 30 days will not receive a refund at all.


    • Please note parking for GMG is on the side of the building or in front of GMG only.
    Please be respectful of the other businesses and do not park in their spaces.

    Please check one:
    I give ____ I do not give____permission for my child to be photographed during gymnastics activities. I do understand that these photos may be used for marketing GMG and its programs.

    Signed:_____________________________________ Date:_____________________

     

    Green Mountain Gymnastics, Inc.
    240 Pioneer Drive, Williston, VT 05495
    Waiver/Release Form
    No child will be allowed to participate in any programs unless this form is completely filled out, signed and filed with GMG prior to commencing participation

    **READ THE FOLLOWING CAREFULLY AND SIGN BELOW.
    NOTE; BOTH PARENTS/CUSTODIAL PARENT AND LEGAL GUARDIAN
    MUST SIGN ON BEHALF OF EACH PARTICIPATING CHILD! **

    Agreement
    In consideration of my child's participation in Green Mountain Gymnastics Inc. (further referred to as GMG) events and activities, I hereby agree to be bound by each of the following terms and conditions:

    1. Eligibility: I agree to comply with the rules of GMG.
    2. Readiness to Participate: I will only participate in those GMG classes, events, competitions and activities for which I believe I am physically and psychologically prepared. Prior to participation, I will have practiced by exercise and will perform only those exercises, which I have accomplished to the degree of confidence necessary to assure I can perform them by myself and without injury.
    3. Medical Attention: I hereby give my consent to GMG and/or host Organization to provide, through a medical staff of choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of my participation in the event, except where such loss or damage is the result of the intentional or reckless conduct of one of the organizations or individuals identified above.
    4. Waiver and Release: 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 gymnastics activities and events. I also release GMG of liability for anyone associated with this gymnast in the event of injury that may be incurred within GMG's premises.

    I further agree that GMG and the sponsor of any GMG event, along with the employees, agents, officers and directors of these organizations, shall not be liable for any losses or damages occurring as a result of my/our child's participation in any GMG event or activity, except where such loss or damage is the result of intentional or reckless conduct on one of the individual (s) /organization (s) mentioned above.

    INFORMATION: Primary Medical Insurance: I am covered by a primary health/medical/accident insurance through:

    ______________________________________________________________________________

    For any athlete who is not yet 18 years old: As the legal parents, guardian or custodial parents of this athlete, I hereby verify by my signature below that I fully understand and accept each of the above conditions for permitting my child to participate in classes, events, competitions and activities conducted by GMG.

    This waiver/ Release form shall remain in effect for as long as ______________________________ (name of Child) participates in any GMG activity until such time of written notice rescinding this waiver/ release is received by GMG.

    Name of Child: _____________________________________________

    Printed name of Both Parents/Legal Guardian(s), Custodial Parent(s):

    _____________________________________     _____________________________________
    Signatures of Both Parents/Legal Guardian(s), Custodial Parent(s):

    _____________________________________     _____________________________________


    Dated: ____/____/____