Pioneer Gymnastics : - Class Registration

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D.O.B

Home Address:

City, State, Zip:

E-mail:

Phone:

D.O.B

Gymnast Name:

Gymnast 2:

D.O.B

Gymnast 3:

Mobile Phone:

Mothers Name:

Fathers Name:

Emergency:

Work #:

Phone #:

FALL II - Nov. 16th - Jan. 22nd

FALL I - Sept. 8th - Nov. 13th

SPRING - Apr. 5th - Jun. 11th

WINTER - Jan. 25th - Apr. 2nd

Gymnast Name:

Gymnast 2:

Gymnast 3:

Select Session:

Please provide the days and times that your are interested in below.

Policies & Procedures - Please read and digitally sign below. Pioneer Gymnastics classes will begin when you sign up. If you are late on signing up, the session will be pro-rated.

Photo Release: Pioneer Gymnastics has my permission to use any video or snapshot of my child taken during the class time. These pictures may be used for promotional purposes for Pioneer Gymnastics.

Medical/Developmental: It is important that Pioneer Gymnastics be made aware of any medical or developmental situation that our gymnasts may have. If your child has a medical problem that may require continual doctor's attention or a developmental problem that is currently being treated, please advise us. It is in the best interest for all of us that this information be shared. Specific examples might be loss of hearing, heart problems, asthma, diabetes, LD, ADD, ADHD, scoliosis, arthritis, etc. Please write any pertinent information below, if none please enter "None":

We do not accept responsibility for lost, stolen, or damaged valuables,
cash, or personal items.

Family Discount: A 10% discount is given for any family with two (2) 
children enrolled in the same session. A 20% discount is given for 
any family with three (3) or more children enrolled in the same session.
This does not apply to special programs that are already discounted.

Membership Fee: The Yearly Membership Fee of $25.00 must 
accompany each registration application. The membership fee 
is an annual fee that is due each year at the time your child registers
for class, i.e. your gymnast registers in September 2006, the membership
fee is not due again until September 2007. This fee in nonrefundable, 
nontransferable as is the deposit to hold a 
space.

The following late fees for unpaid tuition will be applied:

$10.00 if payment is not made by the second class of the session
$25.00 if payment is not made by the third class of the session

Any bank fees associated with checks returned
to us by the bank will be your responsibility and will be billed to your
account.

Medical Treatment: I fully understand that Pioneer Gymnastics staff
members are not physicians or medical practitioners of any kind. 
With the above in mind, I hereby release Pioneer Gymnastics to 
render temporary first aid to my child in the event of any injury or
illness, and if deemed necessary, by the Pioneer Gymnastics staff
to seek medical help and/or call an ambulance.

LIABILITY RELEASE, ACKNOWLEDGEMENT, AND WAIVER:

The undersigned understands, acknowledges and agrees that:
(i) I am aware that the equipment, facilities, and services offered 
by PIONEER GYMNASTICS. involves risks, including, 
but not limited to, risk of bodily injury; (ii) I am making use
of the equipment, facilities and services of PIONEER 
GYMNASTICS. of my own free will; and (iii) I ASSUME 
ALL RISKS ASSOCIATED THEREWITH. On behalf
of myself, my heirs, I hereby release and discharge the
entity that operates PIONEER GYMNASTICS. (the “Owner”)
and all of the affiliates, subsidiaries, employees, directors,
officers, agents, landlords, representatives, successors
and assigns of the Owner from any and all claims or causes
of action arising out of or relating to my use of the equipment,
facilities, and services of that entity, including but not limited to,
those resulting from bodily injury or theft 
of, or loss of, or damage to, property of mine.

I accept all policies

Signature: Date: